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GUM/ID/O&G Flashcards

1
Q

Hiv positive mother vaginal Vs can section

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended

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2
Q

Hiv positive breast feed or not

A

No

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3
Q

Hiv positive pregnantHAART

A

Start immediately

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4
Q

Diagnostic thresholds for gestational diabetes in fasting and 2 hour glucose

A

Fasting 5.6

2 hr 7.8

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5
Q

Management of gestational diabetes

A

If fasting glucose between 5.6 and 7… Then diet exercise. Start Metformin in two weeks if not successful.
If fasting above 7 then insulin, or if there is macrosomia or hydraminios

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6
Q

Viral cause of Kaposi sarcoma

A

HHV 8 (human herpes virus 8

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7
Q

Description of kaposi’s sarcoma

A

Multiple purplish nodules

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8
Q

Viral cause of primary CNS lymphoma in HIV

A

Secondary to EBV… CD4 count approx 50-100

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9
Q

Management of chickenpox exposure in preg

A

Urgent bloods. If no exposure (IgM and IgG neg) then varicella zoster immunoglobulin.
Oral Aciclovir if within 24hr of rash

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10
Q

Risk to mother of chickenpox exposure in preg

A

5 times greater risk of Pneumonitis

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11
Q

Risk to foetus of chickenpox exposure

A

Foetal varicella syndrome, highest risk under 20 weeks…

Features of skin scarring, microphthalmia, limb hypoplasia, microcephaly, learning disabilities

Neonatal Varicella if 5 days before or 2 days after delivery… 20% risk of death!

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12
Q

Who gets HPV vaccine

A

12-13 year old girls

MSM under 45-year-old

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13
Q

treatment of warts

A

podophyllum if multiple, non-keratinised warts.

or cryotherapy for keratinised warts

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14
Q

painless genital ulcers - granuloma inguinale causative organism

A

Klebsiella granulomatis

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15
Q

Causes of false positives in VDRL cardiolipin tests for syphilis

A

False positive if EIA and TPPA negative (which are permanent for life if ever infected)

SLE TB malaria HIV pregnancy leprosy

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16
Q

Causes of false positives in VDRL cardiolipin tests for syphilis

A

False positive if EIA and TPPA negative (which are permanent for life if ever infected)

SLE TB malaria HIV pregnancy leprosy

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17
Q

treatment for eclampsia and what do you monitor

A

IV magnesium. Monitor UO, reflexes, O2 sats and resp rate…

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18
Q

Scabies - permethrin treatment

A

all skin including scalp + leave for 12 hours + retreat in 7 days

The BNF advises to apply the insecticide to all areas, including the face and scalp, contrary to the manufacturer’s recommendation (and common practice).

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19
Q

Features of Lymphogranuloma venereum

A

1) small painless single pustule that became ulcer
2) painful inguinal lymphadenopathy
3) rectal pain and tenesmus

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20
Q

Hiv antibiotic prophylaxis

A

CD4< 200 then Pneumocystis jirovecipneumonia prophylaxis with co-trimoxazole

(Features: dry cough… hepatosplenomegaly… Bilat cxr changes, minimal examination findings)

CD4 <50 then Mycobacterium Avium Intracellulare proph w Clari /Azithro

(features: Diarrhoea, abdo pain. hepatomegaly, fever)

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21
Q

Symptoms of Lymphogranuloma venereum

A

Painless ulcer painful LN
rectal pain and tenesmus

Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) all cause painless genital ulcers.

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22
Q

genital ulcer differentials

A

Multiple painful ulcers with ragged edges, yellow/grey base which bleeds when touched, painful LN = chancroid (H. ducreyi)
Multiple painful blisters/ulcers with tingling pain neuropathic type pain and tender inguinal lymph nodes + systemic symptoms= Genital herpes simplex

painless ulcer + painless LN = syphilis
Single painless ulcer + painful LN = LGV
Indolent painless ulcers ‘regional lymphadenopathy is rare’&raquo_space; Granuloma inguinale

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23
Q

Migraine in pregnancy, paracetamol hasn’t helped, what is second line?

A

Nsaids, but try to avoid in third trimester (stops foramen ovale closure)
Don’t give aspirin in third either
Minimal evidence re triptans

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24
Q

ER negative and HER-2 positive breast cancer… What med do you start?

A

Trastuzumab (Herceptin)… Can causeflu-like symptoms, diarrhoea. Rarely cardiotoxicity

Tamoxifen is only if ER positive

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25
Organism that causes chancroid
Haemophilus ducreyi.... Painful ulcer with ragged border and tender LN
26
Women with vsd. What complication would make becoming pregnant contraindicated?
pulmonary hypertension: pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality
27
HIV neuro symptoms...multiple lesions with ring enhancement
Toxoplasmosis (up to 10% of HIV patients and 50% of cerebral lesions
28
HIV neuro symptoms...single lesion with homogeneous enhancement
CNS lymphoma... accounts for 30% of cerebral lesions in HIV
29
Pcos treatment for hirtuism after trying COCP
Topical eflornithine
30
Advice for statin and pregnancy
Stop 3 months before
31
Pancreatitis in hiv
Most likely cmv, cryptosporidium, microsporidia Or antiretrovirals like didanosine
32
Patient with newly diagnosed hiv gets started on antiretrovirals and becomes generally unwell, haemoptysis and lymphadenopathy. Diagnosis?
Immune reconstitution inflammatory syndrome ... Antiretrovirals unmask underlying infection, e.g. TB
33
Antiepileptics in breast feeding
Almost all ok except barbiturates
34
Diagnosis of hiv seroconversion
HIV PCR and p24 antigen tests can confirm diagnosis
35
presentatin of yelllow fever
flu like illness → brief remission→ followed by jaundice and haematemesis
36
most common organism to caused by dog bite
Pasteurella multocida is a gram-negative coccobacillus which is the most likely organism to be isolated after a dog bite. Streptococcus, Staphylococcus, Neisseria and Enterococcus are also associated with dog bites but are less likely to be isolated than Pasteurella.
37
Patient with HIV gets diarrhoea
cryptosporidium.. treat with supportive therapy
38
patient with HIV, CD4 30, gets fever, diarrhoea and hepatomegaly
mycobacterium avium intracellulare Diagnose w blood culture / bone marrow. Treat w Rifampacin, Ethambutol and Clari (prophylaxis w clari or azithro when CD4 <100)
39
four factors that decrease vertical HIV transmission
Maternal antiviral therapy C section Neonatal antiviral therapy Bottle feeding Decreases chance from 25% to 2%
40
Management of suspected rabies
if already vaccinated then give two further doses of vaccine | If NOT then give Human Rabies Ig and full vaccination
41
Where in the world is malaria chloroquine resistant
Certain ares of Asia and Africa, so treat with artemisinin-based combination therapies ( ACTs )
42
male patient comes into GUM with discharge, microscopy shows neutrophils but no Gram negative diplococci. What is management?
This is non-gonoccocal urethritis | Azithro or Doxy , with contact tracing
43
Management of Gonorrhoea
If no sensitivities known then single dose IM Ceftriaxone (no azithro now) If sensitive, then Cipro PO If needle-phobic then PO cefixime + Azithro
44
Syphilis investigation
``` Cardiolipin tests (VDRL or RPR) Return to negative TrePonemal specific antibody tests (TPHA) remains Positive ```
45
Syphilis secondary features...particularly derm
4-10 weeks later in 25% of untreated, but can recur during latency period too Systemic symptoms like fever, lymphad, Rash on Trunk, palms, soles Buccal 'snail track' ulcers (30%) Condylomata lata (painless, warty lesions on the genitalia)
46
timeline of syphilis infection
Chancre for 3-8/52 25% go to secondary, 4-10/52 later Latent period for 20-40 yr, but 25% get secondary again 33% get tertiary if untreated
47
Congenital syphilis
2/3 asymp at birth but develop signs within 5/52 commonly rash, haemorrhagic rhinitis, lymphad, hepatosplenomeg. ``` after 2yr developed: Blunted incisors (Hutchinson's teeth) and Mulberry molars Saddle nose Linear scars on edge of mouth (rhagades) Keratitis Deafness ```
48
Management of Lymphogramuloma venerium
three weeks of Doxy 100mg BD | or Erythro if pregnant 500mg QDS
49
definition and management of recurrent vaginal candida
more than 4 in a year, confirmed by micro/culture Treat with Fluconazole 150mg every 72hr for three doses then 150mg weekly for 6 months AVOID oral in preg/breast feeding. Use: top imidazole 7-14 days Then Clotrimazole pessary 500mg weekly
50
management of chlamydia
Doxy 100mg BD 7/7 First line or if preg Azithro 1g sing dose followed by 500mg OD x2 This is due to Mycoplasma genitalium being thought to be a significant sexually transmitted pathogen / coinfection
51
Contact tracing timeline for chlamydia
BASHH says 'all sexual partners' should be offered Others say 4/52 for symptomatic men 6/12 for women and asymp men
52
Needlestick injury and risk
Hep B 30% Hep C 3% HIV 0.3%
53
Management of Severe falciparum Malaria
IV artesunate (non-flaciparum Tx is chloroquine except in asia/Africa, which is ACT)
54
Which intracellular protozoa causes each type of Leishmaniasis?
Cutaneous --> "topical" - Leishmania tropical or mexicana Mucocutaneous --> "Buccal" - Leishmania braziliensis Visceral --> Leishmania donoVani
55
What is Groove sign?
Groove sign is separation inguinal nodes by the inguinal ligament and is characteristic of the LGV.
56
young kid...adopted...attends with complete heart block post tonsilitis. what infection?
Diptheria | Adopted is meant to indicate that he may not have been vaccinated appropriately
57
Patient presents with lethargy, pyrexia and headaches. She is a student and returned from a holiday in Ibiza ten days ago Blood film shows atypical lymphocytes
Atypical lymphocytes - ?glandular fever
58
what vaccines are absolutely contra in all patients with HIV
TB BCG Oral polio intranasal influenza Cholera CVD103-HgR
59
A man develops abdominal pain after a holiday where he was walking barefoot in northern Africa. Bloods show an iron deficiency anaemia
Ancylostoma duodenale
60
Pregnant women, 34wk, previously fit and well presents with profuse pain and vomiting. Deranged lfts INR. Glucose 1.8. no haemolysis on blood film. Diagnosis
Acute fatty liver of pregnancy
61
Most common bug causing haemolytic uraemic syndrome
Escherichia coli (STEC) 0157:H7
62
Roll of CD4 in HIV
Used by HIV to enter cells ``` Found on helper T cells. Co-receptor for MHC class II ```
63
Vomiting within 6hr of food, organisms?
Staph A or bacillus cereus
64
Live vaccines
'You Musn't Prescribe BCG Incase They RIP...Shit Yellow fever, MMR, Polio, BCG, Influenza, Typhoid, Rotavirus, Shingles'
65
Which syphilis tests stay positive
Treponemal specific antibody tests E.g.TPHA (Treponema pallidum HaemAgglutination test) remains positive TP = Treated Previously
66
percentage of patients who contract the hepatitis C virus will become chronically infected?
55-85%
67
Thin Vs thick blood film with malaria
Thick is for parasite burden | Thin - better visualisation of the parasites, so speciation
68
Which hep b antigen is marker of infectiousness
Hep b e antigen
69
Most common non falciparum malaria
Plasmodium vivax - Central America , India Ovale is typically in Africa
70
Primaquine in malaria treatment
Use after chloroquine when in or w Vivax or Ovale, to destroy liver hypnozoites and prevent relapse
71
What makes plasmodium knowlesi particularly dangerous
It has shortest erythrocytic replication cycle ---> high parasite counts in short periods of time So severe should be defined as >1% (rather than 2)
72
Management of falciparum malaria with high parasitaemia
>2% then IV artesunate | >10% than exchange transfusion too
73
Blackwater fever
Rare potentially fatal large intravascular haemolysis Black/red urine (haemoglobinuria) Anaemia,jaundice, AKI antimalarial drugs, whole-blood transfusions, and complete bed rest, but even with these measures the mortality remains about 25 to 50 percent...
74
Raised right hemi diaphragm. Organism?
Amoebic liver abscess
75
Mx of familial Mediterranean fever
Colchicine may help

Mrcp (21 decks)

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