gyn1 Flashcards
syphilis vs chancroid
Syphilis -Treponema pallidum. single ulcer, termed chancre, that is painless. No lymphadenopathy
Chancroid- multiple painful ulcers with associated painful lymphadenopathy are present. Haemophilus ducreyi
Donovanosis presentation and Mx
This would present with multiple small painless nodules, which then burst leading to a pustular appearance with exudate
Co - trimoxazole
A 35 year old Fijian man visits the GUM clinic. He has noticed a small genital ulcer that is painless.
On genital examination, there is unilateral inguinal lymphadenopathy.
Given the likely diagnosis, what is the most appropriate management?
Doxycycline
Lymphogranuloma venereum (LGV).
small, single painless ulcer and unilateral lymphadenopathy.
A 28 year old male presents to the genitourinary medicine clinic with a 3 day history of purulent anal discharge with fresh rectal bleeding and rectal pain. His symptoms are relatively severe and are impacting his quality of life. He has regular unprotected anal sexual intercourse.
On examination there is evidence of tender, inflamed local lymph nodes and he was unable to tolerate rectal examination.
What is the most likely cause of his symptoms?
Lymphogranuloma venereum
This patient has lymphogranuloma venereum (LGV) proctitis. It is the most common cause of proctitis amongst homosexual males. LGV is caused by chlamydia trachomatis.
Rectal gonorrhoea tends to be less severe than LGV proctitis. Often it is asymptomatic and tends not to present with tender lymphadenopathy.
In anorectal herpes simplex, the pain is often out of proportion to other proctitis symptoms. It is less common but can present similarly.
Chancroid ulcer and bacteria
Gram-negative rods in a typical “school of fish” pattern. Anaerobic. Haemophilus ducreyi.
Ulcer:
An erythematous papule forms at the site of inoculation, which soon develops into a pustule and then into an excruciatingly painful ulcer, which has a friable base and yellow-grey exudate.Deep ulcer with a soft, irregular border and a friable base
sudden-onset abdominal pain, which typically starts during exercise (such as physical activity or sexual intercourse)
ovarian cyst rupture
early stage cervical cancer in woman who wants more children Mx
For early-stage cervical cancer, a radical trachelectomy is a viable treatment option and also preserves reproductive abilities. remove cervix and nearby tissues
PID more likely to cause
ectopic pregnancy than miscarriage
24F, 4 day history of abdominal cramps, thick yellow vaginal discharge. Multiple sexual partners.
O/E: cervical tenderness, inflamed cervix, thick yellow/green discharge in vaginal vault
microscopy findings?
Intracellular gram-negative diplococci
This patient has signs and symptoms of pelvic inflammatory disease. Gram-negative diplococci inside cells on a vaginal specimen indicate gonorrhoea infection, one of the most common causes of pelvic inflammatory disease.
normal to find
gram + baciilli
gram + cocci =
BV
most common ovarian cyst
functional - follicular
fever, rash, and worsening of existing symptoms due to the release of toxins from dying Treponema pallidum bacteria.
The Jarisch-Herxheimer reaction is a potential complication of treatment for syphilis characterised by
is oral acyclovir 400mg 3 x a day contra indicated in pregnancy
no
A 60 year old woman presents to the GP with a 2 month history of early satiety and bloating. She is otherwise very well with no comorbidities. She has a CA 125 test - result 100 and undergoes urgent abdominal and pelvic ultrasound.
A mixed solid and cystic mass is present on ultrasound and she undergoes MRI staging.
What is the most appropriate next step in her management?
Surgery
This is recommended for histological confirmation, staging and tumour debulking.
Nabothian cysts
are normal cervical findings in women, appearing as small, amber mucous-filled cysts around the cervical os, resulting from epithelial transition areas that secrete and trap mucous.
cervical polyps- cherry red, 40-50y/o post children
A 38-year-old HIV positive man comes to the emergency department with headache and fever for the last two days. He denies neck stiffness and photophobia. A CT Head shows multiple ring enhancing lesions with no mass effect.
What is the most appropriate course of action?
Administer sulfadiazine and pyramethamine
This case describes a most likely case of toxoplasmosis due to the neuroimaging findings as multiple ring enhancing lesions in HIV are virtually diagnostic of toxoplasmosis. This is the correct answer, as treating toxoplasmosis often involves medical management and monitoring to see whether imaging and symptoms improve. Folate is often co-adminstered with sulfadiazine as it can lead to folate deficiency.
ovarian torsion
pelvic US with doppler
PCOS and cancer
PCOS is thought to increase the risk of both endometrial and ovarian cancer by about two to three times.
A palmar and plantar rash with generalised lymphadenopathy and a history of unprotected sex are suggestive of
secondary syphilis. The British Association for Sexual Health and HIV (BASHH) recommend EIA/treponemal chemiluminescent assay (CLIA) as the screening test of choice for syphilis.
A 32 year old woman visits the GUM clinic. She reports that her husband engaged in receptive anal sex 48 hours ago and she has since slept with him without using a condom. She is concerned that she may have contracted HIV and is requesting post-exposure prophylaxis (PEP) therapy. She has no other medical issues, normal renal function and has never had PEP before.
What is the most appropriate initial management of this patient?
Determine HIV status before prescribing PEP therapy
This is correct. HIV testing is required to confirm that patients are not already HIV-positive when they start taking PEP. This helps in monitoring and provides a reference for future testing. In line with BASHH guidelines, clinicians should consider PEP when there is a significant risk of HIV transmission. This includes situations where an individual has had unprotected sexual intercourse with a partner who is known to be HIV-positive or whose HIV status is unknown but engages in high-risk behaviors.
A 22-year-old male presents to the GP with a 2 day history of a ‘burning’ sensation when passing urine. He denies any haematuria or testicular changes, but admits he has noticed some discharge from the tip of the penis. Urethral swab and urine cultures are sent.
Given the likely diagnosis, which of the following complications is this patient at risk of?
urethral stricture from urethritis caused by STI
A 37-year-old gentleman presents to the sexual health clinic with a painful ulcer in his penis. There is no associated discharge.
He states he has recently returned from a holiday to Zambia. He reports having sex with multiple partners during his stay there, but he used condoms at all times.
His blood results come back as normal, aside from mildly raised inflammatory markers.
What is the most likely diagnosis?
Haemophilus ducreyi infection
This man likely has chancroid, a sexually transmitted infection caused by Haemophilus ducreyi and is spread via skin-to-skin contact with affected areas. It is more common in the tropics.
LGV would be painless ulcer and painful inguinal lymphadenopathy and proctocolitis
In patients with suspected Pneumocystis pneumonia, especially those with prior HIV exposure or a history of splenectomy, initiation of
Co-trimoxazole therapy and corticosteroids is crucial for improving outcomes, particularly when oxygen saturations are below acceptable ranges.
motile, flagellated protozoa.
trichomoniasis- metronidazole
According to NHS cervical screening guidelines, women aged 50–64 with a negative HPV test after a previous positive result can
return to routine screening every 5 years. HPV clearance indicates the low likelihood of current or future cervical cell abnormalities. Cytology is unnecessary when the HPV test is negative, as HPV is the primary screening tool for cervical cancer risk.
chancre vs chancroid
chancre - syphillis
chancroid - haem ducreyi
Klebsiella granulomatis.
Granuloma inguinale - beefy red ulcer
A 22-year-old male attends a sexual health clinic with a 4-day history of urethral discharge and dysuria following unprotected sexual intercourse with a new partner 2 weeks ago. On examination, there is evidence of inguinal lymphadenopathy and clear discharge around the urethral meatus. A urethral swab is performed which shows gram-negative diplococci.
What is the most appropriate treatment?
ceftriaxone for gonorrhoea
§Doxycycline is the first-line treatment for Chlamydia. Symptoms of urethral discharge and dysuria may occur in those infected with Chlamydia, however, you would not see inguinal lymphadenopathy. Moreover, Chlamydia is a gram-negative obligatory intracellular pathogen which does not form diplococci.
gonorrhoea treatment in penicillin allergic
Intramuscular gentamicin and oral azithromycin
In patients with a history of severe hypersensitivity reactions (such as anaphylaxis) to penicillin or other beta-lactams, ceftriaxone should be avoided.
cold sores
oral acyclovir
A 42 year-old HIV-positive man on antiretroviral treatment (cART) presents to the GP. He is concerned as he has noticed multiple palpable purple nodular lesions on his back.
What is the most appropriate first step?
Assess compliance with cART
This is the most appropriate initial step that can be easily taken in the GP setting. The most effective treatment for Kaposi’s Sarcoma is commencing cART, thus assessing compliance with their current regimen can inform future treatments
A 44 year old female presents to the Emergency Department complaining of abnormally heavy menstrual bleeding. She has associated abdominal pain and pain on urination. She also has a fever and blood tests show a raised ESR, CRP and leukocytosis.
Given the most likely diagnosis, what investigation will be confirmatory?
Endocervical swab
This is a case of pelvic inflammatory disease, as indexed by dysuria, menorrhagia and objective markers of infection and inflammation. As most causes of PID are infectious in nature, an endocervical swab is indicated to identify the organisms responsible. The common causes are Chlamydia trachomatis or Neisseria gonorrhoeae.
A 27-year-old woman presents to A&E with lower abdominal pain. She reports feeling unwell for the past week and has been having green vaginal discharge. She has never been tested for sexually transmitted infections. On pelvic examination, there is adnexal tenderness and cervical motion tenderness. Her temperature is 38 °C.
Given the likely diagnosis, which of the following is the most appropriate treatment?
Oral doxycycline, oral metronidazole and intramuscular ceftriaxone
This patient likely has pelvic inflammatory disease (PID). NICE guidelines recommend treatment with oral doxycycline, oral metronidazole and intramuscular ceftriaxone. PID involves ascending infection from the lower genital tract to the upper genital tract, most commonly by a sexually transmitted infection such as chlamydia or gonorrhoea. It can lead to infertility, chronic pelvic pain and an increased risk of ectopic pregnancy. It is often diagnosed retrospectively during infertility investigations.
chandelier sign
Chandelier sign is also known as cervical motion tenderness. Cervical excitation is a sign of inflammation of pelvic organs and/or peritoneum. It is tested during a bimanual examination by pressing anteriorly on the cervix with one hand and on the fundus of the uterus with the other hand. This results in severe pain. It is commonly present in pelvic inflammatory disease (the most likely diagnosis here), and occasionally in ectopic pregnancy.
what is acetic acid used for
Acetic acid is a solution applied to the cervix during colposcopy to highlight abnormal cells.
how does doxycycline work
Protein synthesis inhibition by blocking the 30S ribosomal subunit
HIV positive patient with a raised opening pressure on lumbar puncture. findings on investigation
Encapsulated yeast organisms on India ink stain
This is the typical finding in cryptococcal meningitis, which is the most likely diagnosis in a HIV positive patient with a raised opening pressure on lumbar puncture. Approximately 25-30% of patients with cryptococcal meningitis have a normal CSF profile
