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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
What is management of recurrent herpes
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
26
How does herpes present genitally
Crops of blisters which burst quickly and then form ulcers
27
Management of trichomoniasis
Metronidazole in a weeks dose or in 1 large dose Or can do tinidazole
28
Trichomoniasis presentation
Discharge thats yellow and green Strawberry cervix High vaginal pH
29
Investigations for trichomoniasis
Wet mount- motile trophozytes
30
In treatment of candida with fluconazole which medications must rule out and why
SSRI as increases QT
31
What do you do with coil and LNG-IUS during PID
Discuss removing it at first meeting If symptoms have not improved within 72 hours then remove
32
What is PID
Infection of uterus, fallopian tubes and ovaries
33
Causes of PID and most common
Chlamydia- most common Neisseria gonorrhoea Mycoplasma genitalum Mycoplasma hominis
34
Presentation of PID
lower abdominal pain fever deep dyspareunia dysuria and menstrual irregularities may occur vaginal or cervical discharge cervical excitation
35
Management of PID
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
36
What is best treatment if PID swab reveals mycoplasma genitalum
Moxifloxacin
37
Complications of PID
Fitz-Hugh curtis syndrome Infertility Chronic pelvic pain Ectopic pregnancy Abscess
38
Investigations for PID
Pregnancy test Endocervical swab for chlamydia, gonorrhoea and mycoplasma genitalum
39
What is fitz hugh curtis syndrome
RUQ pain with peri-hepatitis most associated with chlamydia
40
What needs to happen for an ecoptic pregnancy to happen
Egg be fertilised in a place other than uterine cavity Implant somewhere with a sufficient blood supply
41
Pathophysiology of ectopic pregnancy
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
Possible presentation of ectopic
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
Risk factors for ectopic pregnancy
Smoking History of ectopic Gynae surgery PID history IUD Endometriosis
44
How long into pregnancy will get pain in an ectopic
If in fallopian tube 6-8 weeks however in somewhere with more space it can increase
45
What is most common site for ectopic
Ampulla of fallopian tubes
46
Possible sites for an ectopic
Tubal - ampulla - isthmal - fimbrial Cervical Ovarian Abdomen Intersitial
47
Most dangerous site for an ectopic pregnancy
Isthmus as narrowest
48
Initial management of suspected ectopic pregnancy
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
What imaging used for ectopic pregnancy
Transvaginal USS the most sensitive Transabdominal if gynae disease like fibroids or unacceptable MRI second line if C-section scar ectopic suspected
50
When consider expectant management for ectopic pregnancy
Minimal symptoms Unruptured No fetal heartbeat Serum HCG under 1000 Mass under 35mm
51
What does expectant management of an ectopic involve
Send home for 48 hours and assessing if is decrease in bHCG
52
When consider methotrexate management for ectopic
Adnexal mass under 35mm No fetal heartbeat In pain but not significant Willbe follow-up
53
How does intrauterine pregnancy affect management of ectopic
If present then medical management not possible
54
How does methotrexate work in ectopic pregnancy
Stops enzymes which maintain pregnancy
55
When operate on ectopic pregnancy
Ruptured Mass over 35mm Fetal HB HCG over 5000
56
When can give choice of medical or surgical management in ectopic
Criteria for medical but HCG 1500-5000
57
What are surgical options for ectopic and what determines
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
Longer term mangement of ectopic
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
What is a pregnancy of unknown location
Positive pregnancy test but no sign on US of a location
60
What do with pregnancy of unknown location
Serial HCG measurements however if very symptomatic this should determine plan Look at serum bHCG as over 1500 indicates an ectopic
61
How to investigate menorrhagia
FBC Consider USS if post-coital bleeding, intermenstrual, pain, compression symptoms or signs on abdo exam
62
If patient haemodynamically unstable what is best operation for ruptured ectopic
Laparotomy
63
What are differentials for PCB
STI Cervical - ectropian - cancer - CIN Vaginal atrophy - post menopausal - breastfeeding Vaginitis
64
Causes of vaginitis
STI Poor hygiene BV Atrophy
65
What are clue cells
Stippled
66
What happens in fitz hugh curtis syndrome
Peri hepatic inflammation where adhesions between the liver and abdominal wall (glissons capsule)
67
Treated for UTI as increased frequency but then comes back with discharge, what has happened
Candida infection as abx immunosuppress
68
What does serum bHCG do in normal pregnancy
Increase of 60% suggests uterine birth however less than this and suspect ectopic
69
What do if vulval symptoms in candida
Clotrimazole cream
70
When refer for PID
Severe symptoms- fever over 38, N&V Peritonitis Abscess Can not rule out appendicitis
71
What are differences in whats done between HVS and endocervical swabs
HVS- MC&S Endocervical- NAAT
72
Management plan for uncomplicated chlamydia infection
Refer to GUM If refuses treat in primary care 1st doxycycline 2nd azithromycin Treat current partners
73
What do you do after chlamydia treatment
Repeat testing 3-6 months later to rule out PID
74
What do you do after gonorrhoea treatment
Test of cure week later
75
Gonorrhoea treatment
Ceftriaxone IM
76
Management of HPV infections
None
77
What is normal physiological discharge like
Clear white mucoid
78
What can change physiological discharge
Around menstrual cycle Mid cycle is thicker then becomes waterier COCP Sexual excitation
79
How should PID be treated in pregnancy
IV abx
80
How does disseminated gonococcal infection present
Polyarthritis Vasculitic rash Fever
81
What is cobblestoned appearance of cervix seen in
Chlamydia
82
What is granuloma inguinale
Donovanoss from klebsiella granulomatis
83
How does donovanosis present
Papule which spreads along skin folds
84
If immunocompromised and come into conract withsomone chick pox positive what do
Give VZIG
85
What can you offer for a Bartholin's cyst if they want to avoid surgery
Balloon catheter insertion
86
Management of severe PID
IV abx
87
What is chandelier sign
Cervical motion tenderness caused by PID
88
What is most likely cause of bartholins abscess
E coli

Gynae (11 decks)

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