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Mrcp > GUM/ID/O&G > Flashcards

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
Q

Organism that causes chancroid

A

Haemophilus ducreyi…. Painful ulcer with ragged border and tender LN

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26
Q

Women with vsd. What complication would make becoming pregnant contraindicated?

A

pulmonary hypertension: pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality

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27
Q

HIV neuro symptoms…multiple lesions with ring enhancement

A

Toxoplasmosis (up to 10% of HIV patients and 50% of cerebral lesions

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28
Q

HIV neuro symptoms…single lesion with homogeneous enhancement

A

CNS lymphoma… accounts for 30% of cerebral lesions in HIV

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29
Q

Pcos treatment for hirtuism after trying COCP

A

Topical eflornithine

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30
Q

Advice for statin and pregnancy

A

Stop 3 months before

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31
Q

Pancreatitis in hiv

A

Most likely cmv, cryptosporidium, microsporidia

Or antiretrovirals like didanosine

32
Q

Patient with newly diagnosed hiv gets started on antiretrovirals and becomes generally unwell, haemoptysis and lymphadenopathy. Diagnosis?

A

Immune reconstitution inflammatory syndrome … Antiretrovirals unmask underlying infection, e.g. TB

33
Q

Antiepileptics in breast feeding

A

Almost all ok except barbiturates

34
Q

Diagnosis of hiv seroconversion

A

HIV PCR and p24 antigen tests can confirm diagnosis

35
Q

presentatin of yelllow fever

A

flu like illness → brief remission→ followed by jaundice and haematemesis

36
Q

most common organism to caused by dog bite

A

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
Q

Patient with HIV gets diarrhoea

A

cryptosporidium.. treat with supportive therapy

38
Q

patient with HIV, CD4 30, gets fever, diarrhoea and hepatomegaly

A

mycobacterium avium intracellulare
Diagnose w blood culture / bone marrow.
Treat w Rifampacin, Ethambutol and Clari
(prophylaxis w clari or azithro when CD4 <100)

39
Q

four factors that decrease vertical HIV transmission

A

Maternal antiviral therapy
C section
Neonatal antiviral therapy
Bottle feeding

Decreases chance from 25% to 2%

40
Q

Management of suspected rabies

A

if already vaccinated then give two further doses of vaccine

If NOT then give Human Rabies Ig and full vaccination

41
Q

Where in the world is malaria chloroquine resistant

A

Certain ares of Asia and Africa, so treat with artemisinin-based combination therapies ( ACTs )

42
Q

male patient comes into GUM with discharge, microscopy shows neutrophils but no Gram negative diplococci. What is management?

A

This is non-gonoccocal urethritis

Azithro or Doxy , with contact tracing

43
Q

Management of Gonorrhoea

A

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
Q

Syphilis investigation

A 
Cardiolipin tests (VDRL or RPR) Return to negative
TrePonemal specific antibody tests  (TPHA) remains Positive
45
Q

Syphilis secondary features…particularly derm

A

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
Q

timeline of syphilis infection

A

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
Q

Congenital syphilis

A

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
Q

Management of Lymphogramuloma venerium

A

three weeks of Doxy 100mg BD

or Erythro if pregnant 500mg QDS

49
Q

definition and management of recurrent vaginal candida

A

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
Q

management of chlamydia

A

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
Q

Contact tracing timeline for chlamydia

A

BASHH says ‘all sexual partners’ should be offered
Others say 4/52 for symptomatic men
6/12 for women and asymp men

52
Q

Needlestick injury and risk

A

Hep B 30%
Hep C 3%
HIV 0.3%

53
Q

Management of Severe falciparum Malaria

A

IV artesunate (non-flaciparum Tx is chloroquine except in asia/Africa, which is ACT)

54
Q

Which intracellular protozoa causes each type of Leishmaniasis?

A

Cutaneous –> “topical” - Leishmania tropical or mexicana
Mucocutaneous –> “Buccal” - Leishmania braziliensis
Visceral –> Leishmania donoVani

55
Q

What is Groove sign?

A

Groove sign is separation inguinal nodes by the inguinal ligament and is characteristic of the LGV.

56
Q

young kid…adopted…attends with complete heart block post tonsilitis. what infection?

A

Diptheria

Adopted is meant to indicate that he may not have been vaccinated appropriately

57
Q

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

A

Atypical lymphocytes - ?glandular fever

58
Q

what vaccines are absolutely contra in all patients with HIV

A

TB BCG
Oral polio
intranasal influenza
Cholera CVD103-HgR

59
Q

A man develops abdominal pain after a holiday where he was walking barefoot in northern Africa. Bloods show an iron deficiency anaemia

A

Ancylostoma duodenale

60
Q

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

A

Acute fatty liver of pregnancy

61
Q

Most common bug causing haemolytic uraemic syndrome

A

Escherichia coli (STEC) 0157:H7

62
Q

Roll of CD4 in HIV

A

Used by HIV to enter cells

Found on helper T cells.
Co-receptor for MHC class II
63
Q

Vomiting within 6hr of food, organisms?

A

Staph A or bacillus cereus

64
Q

Live vaccines

A

‘You Musn’t Prescribe BCG Incase They RIP…Shit

Yellow fever, MMR, Polio, BCG, Influenza, Typhoid, Rotavirus, Shingles’

65
Q

Which syphilis tests stay positive

A

Treponemal specific antibody tests
E.g.TPHA (Treponema pallidum HaemAgglutination test)
remains positive

TP = Treated Previously

66
Q

percentage of patients who contract the hepatitis C virus will become chronically infected?

A

55-85%

67
Q

Thin Vs thick blood film with malaria

A

Thick is for parasite burden

Thin - better visualisation of the parasites, so speciation

68
Q

Which hep b antigen is marker of infectiousness

A

Hep b e antigen

69
Q

Most common non falciparum malaria

A

Plasmodium vivax

  • Central America , India

Ovale is typically in Africa

70
Q

Primaquine in malaria treatment

A

Use after chloroquine when in or w Vivax or Ovale, to destroy liver hypnozoites and prevent relapse

71
Q

What makes plasmodium knowlesi particularly dangerous

A

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
Q

Management of falciparum malaria with high parasitaemia

A

> 2% then IV artesunate

>10% than exchange transfusion too

73
Q

Blackwater fever

A

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
Q

Raised right hemi diaphragm. Organism?

A

Amoebic liver abscess

75
Q

Mx of familial Mediterranean fever

A

Colchicine may help

Mrcp (21 decks)

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