GUM/ID/O&G Flashcards
Hiv positive mother vaginal Vs can section
vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
Hiv positive breast feed or not
No
Hiv positive pregnantHAART
Start immediately
Diagnostic thresholds for gestational diabetes in fasting and 2 hour glucose
Fasting 5.6
2 hr 7.8
Management of gestational diabetes
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
Viral cause of Kaposi sarcoma
HHV 8 (human herpes virus 8
Description of kaposi’s sarcoma
Multiple purplish nodules
Viral cause of primary CNS lymphoma in HIV
Secondary to EBV… CD4 count approx 50-100
Management of chickenpox exposure in preg
Urgent bloods. If no exposure (IgM and IgG neg) then varicella zoster immunoglobulin.
Oral Aciclovir if within 24hr of rash
Risk to mother of chickenpox exposure in preg
5 times greater risk of Pneumonitis
Risk to foetus of chickenpox exposure
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!
Who gets HPV vaccine
12-13 year old girls
MSM under 45-year-old
treatment of warts
podophyllum if multiple, non-keratinised warts.
or cryotherapy for keratinised warts
painless genital ulcers - granuloma inguinale causative organism
Klebsiella granulomatis
Causes of false positives in VDRL cardiolipin tests for syphilis
False positive if EIA and TPPA negative (which are permanent for life if ever infected)
SLE TB malaria HIV pregnancy leprosy
Causes of false positives in VDRL cardiolipin tests for syphilis
False positive if EIA and TPPA negative (which are permanent for life if ever infected)
SLE TB malaria HIV pregnancy leprosy
treatment for eclampsia and what do you monitor
IV magnesium. Monitor UO, reflexes, O2 sats and resp rate…
Scabies - permethrin treatment
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).
Features of Lymphogranuloma venereum
1) small painless single pustule that became ulcer
2) painful inguinal lymphadenopathy
3) rectal pain and tenesmus
Hiv antibiotic prophylaxis
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)
Symptoms of Lymphogranuloma venereum
Painless ulcer painful LN
rectal pain and tenesmus
Syphilis, Lymphogranuloma venereum (LGV) and donovanosis (granuloma inguinal) all cause painless genital ulcers.
genital ulcer differentials
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’»_space; Granuloma inguinale
Migraine in pregnancy, paracetamol hasn’t helped, what is second line?
Nsaids, but try to avoid in third trimester (stops foramen ovale closure)
Don’t give aspirin in third either
Minimal evidence re triptans
ER negative and HER-2 positive breast cancer… What med do you start?
Trastuzumab (Herceptin)… Can causeflu-like symptoms, diarrhoea. Rarely cardiotoxicity
Tamoxifen is only if ER positive
Organism that causes chancroid
Haemophilus ducreyi…. Painful ulcer with ragged border and tender LN
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
HIV neuro symptoms…multiple lesions with ring enhancement
Toxoplasmosis (up to 10% of HIV patients and 50% of cerebral lesions
HIV neuro symptoms…single lesion with homogeneous enhancement
CNS lymphoma… accounts for 30% of cerebral lesions in HIV
Pcos treatment for hirtuism after trying COCP
Topical eflornithine
Advice for statin and pregnancy
Stop 3 months before
Pancreatitis in hiv
Most likely cmv, cryptosporidium, microsporidia
Or antiretrovirals like didanosine
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
Antiepileptics in breast feeding
Almost all ok except barbiturates
Diagnosis of hiv seroconversion
HIV PCR and p24 antigen tests can confirm diagnosis
presentatin of yelllow fever
flu like illness → brief remission→ followed by jaundice and haematemesis
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.
Patient with HIV gets diarrhoea
cryptosporidium.. treat with supportive therapy
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)
four factors that decrease vertical HIV transmission
Maternal antiviral therapy
C section
Neonatal antiviral therapy
Bottle feeding
Decreases chance from 25% to 2%
Management of suspected rabies
if already vaccinated then give two further doses of vaccine
If NOT then give Human Rabies Ig and full vaccination
Where in the world is malaria chloroquine resistant
Certain ares of Asia and Africa, so treat with artemisinin-based combination therapies ( ACTs )
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
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
Syphilis investigation
Cardiolipin tests (VDRL or RPR) Return to negative TrePonemal specific antibody tests (TPHA) remains Positive
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)
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
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
Management of Lymphogramuloma venerium
three weeks of Doxy 100mg BD
or Erythro if pregnant 500mg QDS
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
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
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
Needlestick injury and risk
Hep B 30%
Hep C 3%
HIV 0.3%
Management of Severe falciparum Malaria
IV artesunate (non-flaciparum Tx is chloroquine except in asia/Africa, which is ACT)
Which intracellular protozoa causes each type of Leishmaniasis?
Cutaneous –> “topical” - Leishmania tropical or mexicana
Mucocutaneous –> “Buccal” - Leishmania braziliensis
Visceral –> Leishmania donoVani
What is Groove sign?
Groove sign is separation inguinal nodes by the inguinal ligament and is characteristic of the LGV.
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
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
what vaccines are absolutely contra in all patients with HIV
TB BCG
Oral polio
intranasal influenza
Cholera CVD103-HgR
A man develops abdominal pain after a holiday where he was walking barefoot in northern Africa. Bloods show an iron deficiency anaemia
Ancylostoma duodenale
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
Most common bug causing haemolytic uraemic syndrome
Escherichia coli (STEC) 0157:H7
Roll of CD4 in HIV
Used by HIV to enter cells
Found on helper T cells. Co-receptor for MHC class II
Vomiting within 6hr of food, organisms?
Staph A or bacillus cereus
Live vaccines
‘You Musn’t Prescribe BCG Incase They RIP…Shit
Yellow fever, MMR, Polio, BCG, Influenza, Typhoid, Rotavirus, Shingles’
Which syphilis tests stay positive
Treponemal specific antibody tests
E.g.TPHA (Treponema pallidum HaemAgglutination test)
remains positive
TP = Treated Previously
percentage of patients who contract the hepatitis C virus will become chronically infected?
55-85%
Thin Vs thick blood film with malaria
Thick is for parasite burden
Thin - better visualisation of the parasites, so speciation
Which hep b antigen is marker of infectiousness
Hep b e antigen
Most common non falciparum malaria
Plasmodium vivax
- Central America , India
Ovale is typically in Africa
Primaquine in malaria treatment
Use after chloroquine when in or w Vivax or Ovale, to destroy liver hypnozoites and prevent relapse
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)
Management of falciparum malaria with high parasitaemia
> 2% then IV artesunate
>10% than exchange transfusion too
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…
Raised right hemi diaphragm. Organism?
Amoebic liver abscess
Mx of familial Mediterranean fever
Colchicine may help
