Gynae 3 Flashcards

Question

What are the investigations for neurosyphilis?

Answer 1

- CT/MRI head - LP (raised WCC, raised protein)

Answer 2

**Early (1st and 2nd, early latent):** - Benzathine-Pen (IM, STAT) OR - Doxycycline (BD, 14/7) **Late (late latent, non-neuro 3rd):** - Benzathine-Pen (IM, OW, 3/52) OR - Doxycycline (BD, 28/7) **Neurosyphilis:** - Penicillin (IV, 4-hourly, 14/7) OR - Doxycycline (BD, 28/7) - Prednisolone (OD, 3/7) started 24 hours before treatment to avoid Jarish-Herxheimer reaction **Follow-up:** - Partner notification, repeat bloods at 3/12 (4-fold drop in RPR)

Answer 3

**Transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment. The reaction occurs within 24 hours of antibiotic treatment** - Caused by release of proinflammatory cytokines in response to dying organisms - S/S: 24 hours of a febrile myalgia – rare/serious consequences - Admit mothers >22w when treating

Answer 4

*>Benzathine penicillin greatly improves foetus outcomes* - FGR - Foetal hydrops - Congenital syphilis (may cause long-term disability) - Stillbirth - Preterm birth - Neonatal death **Congenital syphilis:** > (see obstetrics) - Rash on soles of feet and hands ± bone lesions

Answer 5

**The result of ascending infection of the genital tract** (endometritis, salpingitis, tuboovarian abscess) - Most common organism = chlamydia trachomatis (other = N. gonorrhoea, M. genitalium, M. hominis) - Other bacteria – anaerobes, coliforms, mycoplasma genitalium

Answer 6

- <25yo - early age of first coitus - multiple sexual partners - recent new partner - history of STI (partner/woman)

Answer 7

- Asymptomatic (with infertility ± chronic pelvic pain) - Acutely – bilateral lower abdominal pain, PV discharge, fever, irregular PVB, dyspareunia

Answer 8

*Start the ABx before swabs if you suspect PID…* - Triple swabs (2x endocervical, 1x HVS) - Speculum > looks for signs of inflammation/discharge - Bimanual > cervical excitation, adnexal masses (tubo-ovarian abscess) - If tubo-ovarian abscess possible, confirm with TVUSS - If febrile > blood cultures, FBC, CRP - Bloods - HIV, syphilis

Answer 9

**ASSESS PATIENT FOR ADMISSION:** - Admit if pyrexial (>38C) or septic or turbo-ovarian abscess suspected - Otherwise, treat in the community - If managed as OP, see within 2-3 days to assess response to Abx > further follow-up in 2-4 weeks **Outpatient Antibiotics:** All of… - Ceftriaxone 500 mg IM (single dose) - Doxycycline 100 mg BD (oral) for 14 days - Metronidazole 400 mg BD (oral) for 14 days Alternative (treat for 14 days): - Ofloxacin - Metronidazole **Inpatient Antibiotics:** (if pyrexial or oral tx failed) - IV cefoxitin - IV doxycycline Alternative treatment: - IV clindamycin - IV gentamycin **Other** = STI screening, contact tracing, discuss contraception, removal of any IUD, avoid sex

Answer 10

- Fitz-Hugh-Curtis syndrome - Infertility - Ectopic pregnancy (paralyse cilia in Fallopian tubes) - Chronic pelvic pain - Up to 30% require hospital admissions

Answer 11

**A Cyst or abscess of Bartholin’s gland (greater vestibular glands)** - Overlying superinfection by Staphylococcus or GBS - Blockage of a duct to a gland in vagina has become infected

Answer 12

- nulliparous, - previous Bartholin’s cyst, - sexually active - age 20-30

Answer 13

Bartholin’s cysts may extend into the vaginal canal, but labial cysts will remain in the labia

Answer 14

- Unilateral labial swelling, often asymptomatic/painless - Infected: Abscess with cardinal signs of infection, Fever, dyspareunia, pain on sitting or walking

Answer 15

*(N.b. if ≥40yo, consider a vulval biopsy)* - Clinical - If infected > MC&S from abscess – most are sterile but may help organism differentiation

Answer 16

**Asymptomatic:** - Conservative management with sitz baths or warm compresses to aid drainage **Symptomatic:** - **Marsupialisation** (cyst cut open and fluid drained out, then open pouch formed to allow any further fluid to drain and stop cyst from reforming) - GA/SA OR - **Word catheter drainage** (local anaesthetic, outpatient, catheter remains for weeks) **Abscess:** - Spontaneous drainage & conservative management with regular sitz baths and analgesia, OR - Incision and drainage - Plus flucloxacillin / trimethoprim

Answer 17

- Rupture - Recurrence

Answer 18

**Premalignant cellular atypia within squamous epithelium of cervix** - FIGO stage 0 – this is BEFORE cervical cancer - HPV (type 16 and 18) is indicated in >95% cases - Peak 25-29yo; cancer peak age 45-50yo

Answer 19

- Smoking - multiple sexual partners - early age of first intercourse - HIV

Answer 20

- National vaccination for girls and boys aged 12-13yo - If pregnant > invite ≥12w post-partum - Quadrivalent vaccine (Gardasil ©) against HPV 6, 11, 16, 18

Answer 21

- <6m before turning 25yo = first smear - 25-50yo = every 3 years - 50-65yo = every 5 years - 65+ = only if one of your last 3 tests was abnormal - High-risk (i.e. HIV +ve) = every 1 year - Pregnancy = if due when pregnant, delay until ≥3m post-partum - Never sexually active = can opt out

Answer 22

- Inflammation - Age-related atrophic change - Blood on smear

Answer 23

- ↑ nuclear size - ↓ cytoplasm - ↑ nuclear to cytoplasmic ratio - Abnormal nuclear shape – poikilocytosis - ↑ nuclear density – koilocytosis

Answer 24

**CIN 1 (low grade)** Mild dysplasia confined to lower 1/3 of epithelium **CIN 2 (high grade)** Moderate dysplasia affecting lower 2/3 of epithelial thickness **CIN 3 (high grade)** Severe dysplasia extending to full thickness of epithelium (carcinoma in situ) - risk of stage Ia1 FIGO (see cancer)

Answer 25

Symptoms of cervical cancer (PV bleeding – IMB, PCB, PMB)

Answer 26

- Speculum is a ‘small plastic tube’ - Cytology available in 2 weeks, explain role of smear (screen for potentially dangerous changes), mild > HPV test, worst > colposcopy, inadequate sample x3 > colposcopy

Answer 27

*Conservative for CIN1 > smear in 12 months* **LLETZ** - Involves removal of abnormal cells using a thin wire loop that is heated by electric current under LA - SEs: cervical stenosis (cervix narrows or completely closes off), cervical incontinence, pyometra (accumulation of pus in uterine cavity), smear follow-up difficulties - Risks = increased risk of miscarriage (bigger lumen to cervix so harder to close fully) **Cone biopsy:** - Used less frequently and under a GA - Only performed if a large area of tissue needs to be removed **Other:** - Cryotherapy, laser treatment, cold coagulation, hysterectomy - If hysterectomy for CIN > a vault smear must be done at 6m and 18m **Follow-up test of cure (6 months later):** = Smear and HPV test: - NEGATIVE > routine recall (3 years irrespective of age) - POSITIVE > repeat colposcopy to identify residual/untreated CIN

Answer 28

(incl. general procedural risks such as bleeding and infection): - Miscarriage and PTL - CIN can progress to cervical carcinoma (but may also regress spontaneously, esp. when young)

Gynae 3 Flashcards

(52 cards)