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Gynae > Infections > Flashcards

Infections Flashcards

1
Q

What causes vaginal candidiasis

A

80% candida albicans
20% other species

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2
Q

How to diagnose candidiasis

A

Should be able to on examination however if need a high vaginal swab

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3
Q

RFx for candida

A

DM
Steroids
Immunosuppressed
Pregnant

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4
Q

Presentation of candida

A

Cheese like discharge which does not smell
Vulval itching, fissuring, erythema and satellite lesions
Superficial dyspareunia
Dysuria

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5
Q

Management of candida if breastfeeding

A

Topical clotrimazole creams

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6
Q

Management of candidiasis if aged 12-15

A

Topical clotrimazole creams

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7
Q

Management of candidiasis

A

Advise about only using emollients and not soaps, bath bubbles etc
1st line oral fluconazole 1 dose
If contraindicated can use intravaginal clotrimazole (pessary)
If itching use topical clotrimazole cream

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8
Q

Management of severe candida

A

Use a second dose of oral fluconazole 3-4 days later
Come back in a week if not better

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9
Q

What can use if oral fluconazole contraindicated in candida treatment

A

Oral itraconazole
Intravaginal clotrimazole or meconazole

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10
Q

When refer for candida

A

Failure to respond to treatment after a week
12-15
Diagnostic uncertainty

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11
Q

What is defined as recurrent candida

A

4 episodes a year

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12
Q

How investigate recurrent candida

A

Examination to confirm
Check compliance with previous medications
DM test

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13
Q

How manage recurrent candida

A

Induction and maintenance regime
Induction- 3 doses of fluconazole, 1 every 3 days
Maintenance- fluconazole once a week for 6 months

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14
Q

What is bacterial vaginosis

A

Get overgrowth of anaerobic bacteria and less lactic acid producing lactobacilli which increases pH of the vagina

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15
Q

Which bacteria often colonises in BV

A

Gardnerella vaginalis
Mycoplasma hominis

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16
Q

Presentation of BV

A

Thin white/grey and offensive discharge

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17
Q

Management of BV

A

Oral metronidazole for 7 days
Can use 1 big dose if wish
If CI or not preferred can use intravaginal metronidazole or clindamycin

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18
Q

Management of persistent BV

A

Reconsider diagnosis- do speculum and take a sample
Prescribe alternative treatment to one initially used
If not improved after days of oral metro contact GUM

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19
Q

RFs for BV

A

Regular sex
Copper IUD
Douching and bubble bath etc

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20
Q

What do if reccurrent BV

A

At least 4 times a year
Can give metronidazole gel or contact GUM

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21
Q

How is BV diagnosed

A

Amsel criteria- 3 of 4 at least
- pH above 4.5
- clue cells on microscopy
- thin discharge
- positive whiff test

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22
Q

How is BV investigated

A

High vaginal swab for gram staining and microscopy
pH can test using swab from vaginal wall

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23
Q

What is whiff test

A

Add potassium hydroxide and get fishy smell if positive

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24
Q

What is management of genital herpes in a woman

A

Advise about washing in salt water and not using douches etc
Refer to GUM clinic
If not willing/unable to then can prescribe aciclovir or famiciclovir and then recommend follow-up in specialist sexual or at GP in a week

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25
Q

What is management of recurrent herpes

A

1st line- encourage bathing technique measures
2nd line- if fewer than 6 times a year can offer aciclovir for episodic treatment
if over 6 can offer suppressive therapy every day

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26
Q

How does herpes present genitally

A

Crops of blisters which burst quickly and then form ulcers

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27
Q

Management of trichomoniasis

A

Metronidazole in a weeks dose or in 1 large dose
Or can do tinidazole

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28
Q

Trichomoniasis presentation

A

Discharge thats yellow and green
Strawberry cervix
High vaginal pH

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29
Q

Investigations for trichomoniasis

A

Wet mount- motile trophozytes

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30
Q

In treatment of candida with fluconazole which medications must rule out and why

A

SSRI as increases QT

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31
Q

What do you do with coil and LNG-IUS during PID

A

Discuss removing it at first meeting
If symptoms have not improved within 72 hours then remove

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32
Q

What is PID

A

Infection of uterus, fallopian tubes and ovaries

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33
Q

Causes of PID and most common

A

Chlamydia- most common
Neisseria gonorrhoea
Mycoplasma genitalum
Mycoplasma hominis

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34
Q

Presentation of PID

A

lower abdominal pain
fever
deep dyspareunia
dysuria and menstrual irregularities may occur
vaginal or cervical discharge
cervical excitation

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35
Q

Management of PID

A

Ceftriaxone, doxycycline and metronidazole
OR
Ofloxacin or levofloxacin and metronidazole
Moxifloxacin
If high suspicion of gonorrhoea (partern positive, symptoms severe or from abroad) use ceftriaxone, doxycline and metronidazole
Contact partners of last 6 months

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36
Q

What is best treatment if PID swab reveals mycoplasma genitalum

A

Moxifloxacin

37
Q

Complications of PID

A

Fitz-Hugh curtis syndrome
Infertility
Chronic pelvic pain
Ectopic pregnancy
Abscess

38
Q

Investigations for PID

A

Pregnancy test
Endocervical swab for chlamydia, gonorrhoea and mycoplasma genitalum

39
Q

What is fitz hugh curtis syndrome

A

RUQ pain with peri-hepatitis most associated with chlamydia

40
Q

What needs to happen for an ecoptic pregnancy to happen

A

Egg be fertilised in a place other than uterine cavity
Implant somewhere with a sufficient blood supply

41
Q

Pathophysiology of ectopic pregnancy

A

If egg implants in ampulla of fallopian tube then egg will grow as per typical pregnancy
Then size will become too big for the fallopian tube and it will burst

42
Q

Possible presentation of ectopic

A

Nausea and fullness of breath
Missed period
Slight abdo pain which can refer to shoulder
Then pain will become very severe which perforates the fallopian tube
Can get vaginal bleeding here too

43
Q

Risk factors for ectopic pregnancy

A

Smoking
History of ectopic
Gynae surgery
PID history
IUD
Endometriosis

44
Q

How long into pregnancy will get pain in an ectopic

A

If in fallopian tube 6-8 weeks however in somewhere with more space it can increase

45
Q

What is most common site for ectopic

A

Ampulla of fallopian tubes

46
Q

Possible sites for an ectopic

A

Tubal
- ampulla
- isthmal
- fimbrial
Cervical
Ovarian
Abdomen
Intersitial

47
Q

Most dangerous site for an ectopic pregnancy

A

Isthmus as narrowest

48
Q

Initial management of suspected ectopic pregnancy

A

Assess for immediate ambulance
- tachycardia
- pallor
- hypotensive
- presyncope
If not then do a pregnancy test which if comes back positive do an abdo exam
- if tenderness or pain suspect ecoptic and sent to early pregnancy unit or out of hours gynae
If no abdo pain do light pelvic exam
- if tenderness then EPU or out of hours gynae
If no pelvic tenderness assess whether under or over 6 weeks pregnant
- under 6 weeks do pregnancy test in a week and return if positive if symptoms return
- over 6 weeks refer to early pregnancy unit

49
Q

What imaging used for ectopic pregnancy

A

Transvaginal USS the most sensitive
Transabdominal if gynae disease like fibroids or unacceptable
MRI second line if C-section scar ectopic suspected

50
Q

When consider expectant management for ectopic pregnancy

A

Minimal symptoms
Unruptured
No fetal heartbeat
Serum HCG under 1000
Mass under 35mm

51
Q

What does expectant management of an ectopic involve

A

Send home for 48 hours and assessing if is decrease in bHCG

52
Q

When consider methotrexate management for ectopic

A

Adnexal mass under 35mm
No fetal heartbeat
In pain but not significant
Willbe follow-up

53
Q

How does intrauterine pregnancy affect management of ectopic

A

If present then medical management not possible

54
Q

How does methotrexate work in ectopic pregnancy

A

Stops enzymes which maintain pregnancy

55
Q

When operate on ectopic pregnancy

A

Ruptured
Mass over 35mm
Fetal HB
HCG over 5000

56
Q

When can give choice of medical or surgical management in ectopic

A

Criteria for medical but HCG 1500-5000

57
Q

What are surgical options for ectopic and what determines

A

Saplingectomy 1st line if no rfx for infertility
Saplingotomy if rf for infertility
Give anti-RHD to all rhesus negative people who have had removal of ectopic surigcally

58
Q

Longer term mangement of ectopic

A

Unless has had saplingectomy must be followed up to have HCG levels monitored to see how long take to return to non-pregnant levels
May take 6 weeks

59
Q

What is a pregnancy of unknown location

A

Positive pregnancy test but no sign on US of a location

60
Q

What do with pregnancy of unknown location

A

Serial HCG measurements however if very symptomatic this should determine plan
Look at serum bHCG as over 1500 indicates an ectopic

61
Q

How to investigate menorrhagia

A

FBC
Consider USS if post-coital bleeding, intermenstrual, pain, compression symptoms or signs on abdo exam

62
Q

If patient haemodynamically unstable what is best operation for ruptured ectopic

A

Laparotomy

63
Q

What are differentials for PCB

A

STI
Cervical
- ectropian
- cancer
- CIN
Vaginal atrophy
- post menopausal
- breastfeeding
Vaginitis

64
Q

Causes of vaginitis

A

STI
Poor hygiene
BV
Atrophy

65
Q

What are clue cells

A

Stippled

66
Q

What happens in fitz hugh curtis syndrome

A

Peri hepatic inflammation where adhesions between the liver and abdominal wall (glissons capsule)

67
Q

Treated for UTI as increased frequency but then comes back with discharge, what has happened

A

Candida infection as abx immunosuppress

68
Q

What does serum bHCG do in normal pregnancy

A

Increase of 60% suggests uterine birth however less than this and suspect ectopic

69
Q

What do if vulval symptoms in candida

A

Clotrimazole cream

70
Q

When refer for PID

A

Severe symptoms- fever over 38, N&V
Peritonitis
Abscess
Can not rule out appendicitis

71
Q

What are differences in whats done between HVS and endocervical swabs

A

HVS- MC&S
Endocervical- NAAT

72
Q

Management plan for uncomplicated chlamydia infection

A

Refer to GUM
If refuses treat in primary care
1st doxycycline
2nd azithromycin
Treat current partners

73
Q

What do you do after chlamydia treatment

A

Repeat testing 3-6 months later to rule out PID

74
Q

What do you do after gonorrhoea treatment

A

Test of cure week later

75
Q

Gonorrhoea treatment

A

Ceftriaxone IM

76
Q

Management of HPV infections

A

None

77
Q

What is normal physiological discharge like

A

Clear white mucoid

78
Q

What can change physiological discharge

A

Around menstrual cycle
Mid cycle is thicker then becomes waterier
COCP
Sexual excitation

79
Q

How should PID be treated in pregnancy

A

IV abx

80
Q

How does disseminated gonococcal infection present

A

Polyarthritis
Vasculitic rash
Fever

81
Q

What is cobblestoned appearance of cervix seen in

A

Chlamydia

82
Q

What is granuloma inguinale

A

Donovanoss from klebsiella granulomatis

83
Q

How does donovanosis present

A

Papule which spreads along skin folds

84
Q

If immunocompromised and come into conract withsomone chick pox positive what do

A

Give VZIG

85
Q

What can you offer for a Bartholin’s cyst if they want to avoid surgery

A

Balloon catheter insertion

86
Q

Management of severe PID

A

IV abx

87
Q

What is chandelier sign

A

Cervical motion tenderness caused by PID

88
Q

What is most likely cause of bartholins abscess

A

E coli

Gynae (11 decks)

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