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Obs & Gynae > Infection > Flashcards

Infection Flashcards

1
Q

What is the function of lactobacilli in the vagina?

A

Produce lactic acid, keeping pH of the vagina low and preventing the overgrowth of other bacteria

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2
Q

What causes bacterial vaginosis? What is a commonly

A

Imbalance of normal bacteria found in the vagina - reduction in lactobacilli and overgrowth of other bacteria

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3
Q

What bacteria are usually seen in increased quantities in bacterial vaginosis?

A

Anaerobes - e.g. Gardnerella vaginalis

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4
Q

State two complications of bacterial vaginosis infection

A

Early delivery in pregnant women

Increased risk of transmitting other STIs

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5
Q

What type of discharge is seen in bacterial vaginosis?

A

Fishy smelling, watery and grey discharge

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6
Q

Apart from fishy, watery and grey discharge what other symptom can be seen in bacterial vaginosis?

A

Dysuria

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7
Q

What vaginal pH will be seen in bacterial vaginosis?

What cells on microscopy suggest bacterial vaginosis?

A

High pH

Clue cells

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8
Q

What is the management of bacterial vaginosis? (3)

A

Vaginal swabs to exclude other STIs

Avoid vaginal irritation/soaps that could disrupt normal flora

METRONIDAZOLE

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9
Q

What is the first line antibiotic for bacterial vaginosis?

A

Metronidazole

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10
Q

What type of infection is candidiasis? What is another name for candidiasis?

A

Fungal infection

Thrush

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11
Q

Name two groups of patients in which candidiasis (thrush) is more common

A

Immunocompromised patients

Diabetics

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12
Q

What type of discharge is seen in candidiasis (thrush)?

A

Thick, white, cottage cheese discharge

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13
Q

As well as a thick, white, ‘cottage cheese’ like discharge what other symptoms can be seen in candidiasis (thrush)? (2)

A

Itch

Vulval/vaginal irritation or pain

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14
Q

What are the management options for candidiasis? (3)

A 
Clotrimazole cream
Clotrimazole pessary (one-off)
Oral fluconazole (150mg, one-off)
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15
Q

What type of bacteria is Neisseria gonorrhoeae?

A

Gram negative diplococcus

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16
Q

HPV is the most common causes of ________ cancer

A

Cervical cancer

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17
Q

What other cancers is HPV linked to?

A 
Anal
Vulval
Vaginal
Penis
Mouth
Throat
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18
Q

How does HPV cause disease and cancer?

A

Invades cells and interrupts normal replication process by inhibiting tumour suppressor genes p53 and pRb

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19
Q

How is HPV transmitted?

A

Sexually tansmitted

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20
Q

What strains of HPV cause genital warts?

A

6, 11

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21
Q

What strains of HPV cause cervical cancer?

A

16, 18

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22
Q

What strains of HPV does the Gardasil vaccine work against?

A

6, 11, 16 and 18

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23
Q

Who is the HPV offered to? (2)

A

All girls from age 12

Boys with HIV

24
Q

What is typically more symptomatic - chlamydia or gonorrhoea?

A

Gonorrhoea

25
Q

Where is Neisseria gonorrhoea found in infected women?

A

Endocervix of women

26
Q

What type of discharge is associated with gonorrhoea infection?

A

Odourless, green, purulent discharge

27
Q

Apart from odourless, green, purulent discharge what other symptoms can be seen in gonorrhea infection? (3)

A

Dysuria
Pelvic pain
Testicular pain

28
Q

How can gonorrhea be tested for in women/men?

A

NAAT (nucleic acid amplification testing) of…

Endocervical swabs (women)
First pass urine (men)
29
Q

What is the typical drug regimen for a gonorrhea infection?

A

Single dose of ceftriaxone 500mg IM and azithromycin 1g oral

30
Q

What is the name of bacteria that causes a chlamydia infection?

A

Chlamydia trachomatis

31
Q

What type of bacteria is chlamydia trachomatis?

A

Intracellular gram negative bacteria

32
Q

What is the most common STI in the UK?

A

Chlamydia

33
Q

Chlamydia infection is typically asymptomatic, but can present with which other symptoms?

A

PV discharge
Pelvic pain
Abnormal bleeding
Dyspareunia

34
Q

What signs can be seen on examination in a chlamydia infection?

A

Cervical motion tenderness (cervical excitation)
Fever
Purulent discharge
Pelvic tenderness

35
Q

How is chlamydia diagnosed in men/women?

A

NAAT (nucleic acid amplification testing) of…

Vulvovaginal swabs (women)
First pass urine (men)
36
Q

Is a test for cure typically required in the treatment of…

Gonorrhoea infection

Chlamydia infection

A

Gonorrhoea = usually required

Chlamydia = not required

37
Q

What is the medical management of a chlamydia infection? (2 options)

A

Doxycycline for 7 days OR single dose 1g azithromycin

38
Q

What is lymphogranuloma venereum?

What is the treatment?

A

Complication of chlamydia infection where lymphoid tissue around the site of infection becomes infected

Same as chlamydia treatment (doxy 7 days or 1g azithromycin)

39
Q

What are the three stages seen in lymphogrnauloma venereum?

A

1st = painless ulcer

2nd = lymphadenitis

3rd = inflammation of rectum and anus

40
Q

What is the most common cause of pelvic inflammatory disease?

A

STI - infection spreading up through the cervix

41
Q

What are two complications of PID?

A

Infertility - due to scarring and adhesions

Chronic pelvic pain

42
Q

What are the two most common causative organisms for PID?

A

Chlamydia trachomatis

Neisseria gonorrhoeae

43
Q

What are some symptoms of PID?

A 
Pelvic pain
Fever
Dysuria
Deep dyspareunia
Discharge
IMB/Post-coital bleeding/Menorrhagia
44
Q

What signs can be seen on examination in a case of PID?

A

Cervical motion tenderness (extreme pain on bimanual exam)

Uterine/adnexal tenderness on palpation

45
Q

What are the NICE guidelines for medical management of PID? (2 options)

A

Oral ofloxacin 400mg BD + Oral metronidazole 400mg BD (14 days)

IM ceftriaxone 500mg (single) + oral doxycycline 100mg BD + oral metronidazole 400mg BD (14 days)

46
Q

What is Fitz-Hugh-Curtis syndrome?

What are the symptoms?

A

Complication of PID where there is inflammation of the liver capsule and adhesions form between the liver and peritoneum

RUQ pain
Shoulder tip pain

47
Q

What two conditions does herpes simplex virus cause?

A

Cold sores

Genital herpes

48
Q

Which strain of HPV typically causes cold sores?

Which strain of HPV typically causes genital herpes?

A

HSV-1

HSV-2

49
Q

What are stomatitis herpetiformis?

A

Apthous ulcers (small, painful oral ulcers) that can be caused by HSV

50
Q

What are the symptoms of genital herpes?

A

Labial ulceration/vesicular lesions
Pain
No discharge

51
Q

How is genital herpes diagnosed?

A

Clinically

Swab for viral PCR

52
Q

What is the management of HSV infection?

A

Oral aciclovir (stomatitis herpetiformis/genital)

Topical aciclovir (cold sores)

53
Q

Is aciclovir contraindicated for the treatment of HSV in pregnant women?

A

No

54
Q

Why is it important to treat genital herpes in pregnant women?

A

Neonatal herpes simplex infection carries high morbidity and mortality

55
Q

Does genital herpes increase the risk of miscarriage?

A

NO

56
Q

How is mode of delivery managed in pregnant women with HSV infection?

A

Lesions appearing for first time after 28 weeks? —> Elective c-section at term

Known recurrent genital herpes? —> start aciclovir, risk of transmission with vaginal delivery low

Obs & Gynae (6 decks)

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