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Gynaecology > Gynae infections > Flashcards

Gynae infections Flashcards

1
Q

4 groups of women prone to thrush

A

pregnant
diabetic
on antibiotics
immunocompromised

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2
Q

oral thrush treatment is fluconazole. What’s the cream / pessary called?

A

clotrimazole

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3
Q

vaginal lactobacilli flora overgrown by anaerobes, mycoplasma etc. What’s this?

A

bacterial vaginosis

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4
Q

The vulva is red and itchy in BV. True or false?

A

false!!

grey discharge, fishy smell

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5
Q

what happens to the pH of the vagina in BV?

A

raised pH - alkaline

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6
Q

add KOH to vaginal discharge, and get a strong fishy odour. what is this test called?

A

‘whiff test’ for BV

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7
Q

what do you see on microscopy with BV?

A

clue cells

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8
Q

what is the treatment for BV?

A

metronidazole cream

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9
Q

which STI is caused by an obligate intracellular parasite?

A

chlamydia (chlamydia trachomatis)

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10
Q

what is the treatment for chlamydia if she’s pregnant

A

azithromycin

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11
Q

what antibiotic is used to treat chlamydia

A

doxycycline

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12
Q

what are the two main complications of chlamydia

A

PID

reiter’s syndrome

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13
Q

what’s is the triad of reiter’s syndrome

A

urethritis, conjunctivitis, arthritis

cant pee cant see cant climb a tree

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14
Q

what does NAAT stand for

A

nucleic acid amplification testing

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15
Q

what do you see on microscopy for chlamydia?

A

nothing! chalmydia invisible on microscopy

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16
Q

what test is diagnostic for chlamydia

A

NAAT (women - vaginal swab) (men - first void urine)

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17
Q

what are the main symptoms of chlamydia for women

A

often asymp.
urethritis
vaginal discharge

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18
Q

what organism causes trichomoniasis

A

trichomonas vaginalis (protozoan)

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19
Q

what sti causes strawberry cervix

A

trichomoniasis

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20
Q

what kind of discharge do you get with trichomonas

A

grey green frothy

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21
Q

which sti is diagnosed with wet film on microscopy

A

trichomoniasis

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22
Q

what is treatment for trichomoniasis

A

metronidazole

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23
Q

which sti is caused by a gram neg diplococcus

A

gonorrhoea (Neisseria gonorrhoea)

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24
Q

Gonorrhoea is often asymptomatic. Symptoms for women include urethritis and vaginal discharge. Give me two more.

A

inter-menstrual bleeding

Bartholinitis

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25
Q

investigations for gonorrhoea

A

NAAT urine

or swab –> microscopy, culture and sensitivities

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26
Q

where would you get a swab for gonorrhoea from MSM

A

urethra + rectum

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27
Q

where do you get a gonorrhoea/chlamydia swab from women

A

endocervical (high vaginal)

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28
Q

what does high vaginal CHARCOAL swab test for

A

BV and trichomoniasis

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29
Q

what is the treatment for gonorrhoea

A

antibiotics according to sensitivities

e.g. im ceftriaxone

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30
Q

what are three dodgy complications of gonorrhoea

A

PID
septic arthritis
opthalma neonatorum

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31
Q

which sti is caused by a spirochaete

A

syphilis (treponema pallidum)

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32
Q

which sti is highly infectious especially during oral sex

A

syphilis

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33
Q

apart from sexually, how else can syphilis be transmitted?

A

transplacentally

can cause miscarriage, seizures, congenital abnormalities

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34
Q

what is the sign in primary syphilis

A

chancre (painless ulcer at the site of infection. heals)

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35
Q

weeks or months after the primary infection, patients can get a rash, oral-snail track ulcers, meningism, lymphadenopathy and warts. What condition is this?

A

secondary syphilis

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36
Q

what are the warts called in secondary syphilis

A

condylomata lata

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37
Q

where do you get a rash in secondary syphilis

A

trunk palms soles

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38
Q

what is the sign in tertiary syphilis

A

gummas

granulomas in skin/joints/organs

39
Q

name the two key organs that get affected in quaternary syphilis

A

heart

brain

40
Q

what heart condition do you get in quaternary syphilis

A

aortic aneurysm (syphilitic aortitis)

41
Q

Name three features of neurosyphilis

A

Cranial nerve palsies
dementia
tabes dorsalis ataxia

42
Q

what is tabes dorsalis?

A

ataxia in quaternary syphilis (dorsal columns)

43
Q

what are the investigations for syphilis?

A

miscroscopy of lesions

serology

44
Q

what do you find on microscopy of lesions in syphilis

A

treponemes

45
Q

what do you find on serology in syphilis

A

treponeme antibodies

46
Q

what is the treatment for syphilis?

A

IM penicillin

47
Q

which are the two commonest HPV types causing genital warts

A

6+ 11

48
Q

which are the two baddest HPV types

A

16+ 18

49
Q

which HPV types does the quadrivalent vaccine cover?

A

6 + 11

16 + 18

50
Q

what is the treatment for genital warts (condylomata accuminata)?

A

topical podophyllin

51
Q

if genital warts are resistant to topical podophyllin, what is the next treatment?

A

cryotherapy / cautery

still, high recurrence

52
Q

which HSV is most likely to cause herpes encephalitis

A

HSV1

53
Q

which is the most common form of HSV

A

HSV 2

54
Q

which HSV is cold sores usually

A

HSV1

55
Q

In the primary herpes infection, as well as painful ulcers around the introitus, what are other possible symptoms?

A

lymphadenopathy

dysuria

56
Q

In what percent of HSV patients does it reactivate after primary infection?

A

75%

57
Q

where does HSV lie dormant?

A

dorsal root ganglia

58
Q

what is the investigation for herpes, after examining?

A

viral swabs

59
Q

give me three possible complications of herpes

A
  • aseptic meningitis
  • herpes encephalitis
  • neonatal herpes
60
Q

explain R = BCD

A

reproductive rate (of STI) = infectivity rate x partners over time x duration of infection

61
Q

give me three reasons why partner tracing is important

A
  1. break chain of transmission
  2. prevent re-infection of treated patients
  3. prevent complications of untreated infection in partners
62
Q

explain primary, secondary and tertiary prevention of STIs

A 
primary = decrease risk of acquiring
secondary = case finding
tertiary = decrease morbidity /mortality
63
Q

PID almost never occurs in presence of viable pregnancy. True or false?

A

true

64
Q

Three risk factors for PID

A

multiple partners
unprotected sex
instrumentation (coil, top, erpc)

65
Q

PID can be from infection ascending spontaneously, by birth complication, or by instrumentation such as… (x3)

A

coil
ERPC
TOP

66
Q

PID if often polymicrobial (e.g. chlamydia plus gonorrhoea). True or false.

A

true

67
Q

RUQ pain in a patient with PID. What is this likely to be?

A

FITZ-HUGH CURTIS SYNDROME (PERIHEPATITIS)

occurs in 10% of PID

68
Q

What is finding on examination of acute PID?

A

cervical excitation

adnexal tenderness

69
Q

PID is often asymptomatic for a while. But it can present acutely with what symptoms?

A 
pain (bilateral lower abdo)
deep dyspareunia 
discharge 
fever
abnormal bleeding
70
Q

What are the investigations for suspected PID (give me a few)…. and what is the gold standard diagnostic test?

A

endocervical swabs (chlamydia/gonorrhoea)
blood cultures, WBC, CRP
pelvic ultrasound

diagnostic = LAPAROSCOPY + fimbrial biopsy + culture (after you’ve reviewed them for 24hrs)

71
Q

What investigation is gold standard diagnostic for PID?

A

laparoscopy + fimbrial biopsy+culture

72
Q

Give me an EARLY complication of acute PID…

A

abscess / pyosalpinx

73
Q

Give me a LATE complication of acute PID

A

subfertility
ectopic preg
progression to chronic PID …

74
Q

When is PID chronic?

A

when there’s persisting infection

75
Q

give me three symptoms of chronic PID

A

chronic pelvic pain
dysmenorrhoea
deep dyspareunia

76
Q

HOW DO YOU TREAT PID ? xx

A

IM ceftriaxone
then
2wks doxycycline + metronidazole

if acute - +analgesics, maybe admit for IV Abx

77
Q

IM ceftriaxone
then
2wks doxycycline + metronidazole

… What is this the treatment for?

A

PID

78
Q

What two surgeries can be done for CHRONIC PID?

A

adhesiolysis

salpingectomy

79
Q

HIV is a single stranded RNA virus. True or false?

A

true

80
Q

What is the maximum time from exposure PEP can be started?

A

72hrs

81
Q

What is absolute contraindication for VBAC ?

A

Classical C-Section

due to risk of uterine rupture

82
Q

What is the role of Kleihauer test in rhesus disease?

A

assess presence of foetal blood in maternal circulation

83
Q

Which point during pregnancy carries the greatest risk of developing a VTE?

A

postnatal

84
Q

Which syndrome describes the development of intrauterine adhesions?

A

Ashermann’s

85
Q

first line treatment for cervical ectropion?

A

stop oestrogen-containing meds!

86
Q

What laparoscopic treatment for bad PCOS INFERTILITY?

A

ovarian drilling

87
Q

what disease do you perihepatitis Fitz High Curtis syndrome in?

A

PID (10%)

RUQ pain

88
Q

PID almost never occurs in the presence of a viable preg. True or false?

A

true

89
Q

3 risk factors for PID

A

multiple partners
unprotected sex
instrumentation (coil, ERPC, ToP)

90
Q

Pus in the tubes. What’s this?

A

pyosalpinx (chronic PID)

91
Q

Fluid in the tubes. What’s this?

A

hydrosalpinx (chronic PID)

92
Q

on examination of PID?

A

cervical excitation

adnexal tenderness

93
Q

If acute PID is severe, what symptoms do you expect??

A

high fever, tachy, peritonitic

94
Q

24 yr old presents with bilateral lower abdo pain, with deep dyspareunia. She has RFs for PID. What other symptoms would you ask about.

A

discharge
abnormal bleeding
fever

Gynaecology (8 decks)

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