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Obs and Gynae > infections/contraception > Flashcards

infections/contraception Flashcards

1
Q

Male symptoms of STIs?

A

Burning whilst peeing, discharge, blood, swelling, pain in testicles, anal symptoms, rash/lump/bump

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2
Q

What do you ask about in sexual history taking for GUM’?

A

when did you have sex? regular/casual? male/female? oral/anal? giving/receiving? when did you sleep with someone else?

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3
Q

What questions do you need to ask the individual about the type of people they’ve slept with?

A

Any one from outside the UK? any one using IV drugs? ever paid for sex?

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4
Q

How would you determine if the patient has had any BBV?

A

any transfusions? surgery abroad? had a HIV test? vaccinations?

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5
Q

What do you need to ask about in SH at GUM?

A

smoking, drinking, recreational drugs? ever not consented? OTC?

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6
Q

What and where do you test in male (homosexual) GUm clinic?

A

swab throat and penis for G, urine sample for C, rectal swab for C and G, blood test for HIV/S/hepatitis

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7
Q

Symptoms of female STI?

A

Discharge, itch, bleeding IMB/PC, pain, burn when peeing, bowel changes, painful sex, fever, lumps/bumps/rashes

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8
Q

Specific questions you need to ask a female at GUM clinic?

A

period history, pregnancy, smear

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9
Q

How many days before period does ovum get released?

A

14 days

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10
Q

How many hours does ovum survive for?

A

48 hours

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11
Q

How many mls is each ejaculate and how many sperm present?

A

3-5mls with 350,000,000 sperm

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12
Q

How long does sperm survive in female genital tract for?

A

3-4 days

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13
Q

What physical changes are monitored as signs of fertility in the natural family planning method?

A

cervical mucus changes, basal body temp, knowledge of regular cycles

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14
Q

why is coitus interruptus not recommended?

A

sperm found in preejaculate

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15
Q

Name a contraceptive patch, how often does it need to be changed, what hormones does it secrete

A

EVRA, every week change, 4th week no patch, Combined

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16
Q

Name a vaginal contraceptive ring, how often does it need to be changed, what hormones are secreted

A

NUVARING, 3 weeks with the ring in and then 1 ring free week, Combined

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17
Q

What questions do you need to ask someone wanting the emergency pill?

A

What happened, LMP, cycle, casual/regular, any chronic health issues, any medication, any other risks in cycle

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18
Q

Name 2 types of emergency pill?

A

Levonelle, EllaOne

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19
Q

How many days is levonelle effective for?

A

3

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20
Q

What is contained within Levonelle?

A

1500ug of Levonorgestrel

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21
Q

What is the mode of action of Levonelle?

A

Delays ovulation

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22
Q

What types of drugs do Levonelle interact with? How do you combat

A

Liver enzyme inducing drugs so need increased dose

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23
Q

Ho many days is EllaOne effective for?

A

5 days

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24
Q

What is contained within EllaOne and dosage?

A

Ullipristal acetate 30mg

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25
Q

How does EllaOne act to prevent pregnancy?

A

Progesterone receptor blocker and delays ovulation

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26
Q

Contraindications for giving EllaOne?

A

breast feeding, cardiac arrhythmias, severe liver or renal disease, severe asthma

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27
Q

What types of drugs do EllaOne interact with? How do you combat

A

Liver enzyme inducing drugs, you cannot give EllaOne. Anything that raises gastric ph like PPIs,

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28
Q

How many days after USPI can the CUD be inserted?

A

5 days

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29
Q

What is pearl index and what is the value for cocp

A

pearl index is the failure rate per 100 woman years and for cocp it is 0.5

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30
Q

What are the pack sizes of cOCP

A

21 day or 28 day with 7 dummy pills

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31
Q

what is the 7 day rule in pill taking?

A

If you miss a pill then it takes 7 days for the effectiveness to return

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32
Q

Contraindications for cOCP

A

circulatory disease, focal migraines, hypertension, liver disease, gallstone history, steroid dependant cancers, undiagnosed genital tract bleeding, pregnancy, BMI over 34

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33
Q

What is it important to ask about in FH of someone wanting to start cOCP?

A

any TE in the under 45s

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34
Q

What is the pearl index and what is it for POP?

A

pearl index is a measure of how many women will get pregant in 100 years of taking the pill, for POP it is 2-4

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35
Q

If you miss a POP, how many days till its effects are restored?

A

2 days

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36
Q

Mode of action of the POP?

A

alters cervical mucus, alters endometrium, affects tubal motility

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37
Q

Contraindications to POP?

A

undiagnosed bleeding, steroid dependant cancer, severe arterial or liver disease

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38
Q

Progestogenic SEs?

A

headache, skin changes, mood changes

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39
Q

What is the newest POP available?

A

Ceraxette

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40
Q

What are 2 risks of taking the POP?

A

ectopic pregnancy and functional ovarian cysts

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41
Q

What is contained within Ceraxette and what is pearl index?

A

ceraxette contains desogestrel with pear index of 0.4-1

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42
Q

What does LARC stand for and what is classified as one?

A

Long acting reversible contraception which lasts longer than 4 weeks

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43
Q

What is nexplanon? contains what? Pearl index?

A

subdermal implant, etonorgestrel, 0.1,

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44
Q

What is depoprovera? how often? drug and dose?

A

IM depot injection every 12 weeks, depomedroxyprogesterone acetate 150mg

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45
Q

What is the main risk of depoprovera?

A

osteoporosis

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46
Q

How do you assess for osteoporosis risk?

A

unexplained fractures, poor diet, low BMI, heavy alcohol use, steroid use, under 20 or over 45

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47
Q

SE of depoprovera?

A

progestogenic SE (mood changes, acne, headache)

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48
Q

What is found on the stem of the mirena coil?

A

Progestogen

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49
Q

What is the pearl index of the mirena coil?

A

0.3

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50
Q

contraindications for the mirena coil?

A

ongoing undiagnosed vaginal bleeding, recent trophoblastic disease, delivery in the last 4 weeks, CV disease, steroid dependant cancers, active pelvic infection

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51
Q

Risks of mirena coil and copper coil?

A

Perforation, ectopic pregnancies, PID (from preexisting), fall out

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52
Q

When is Jaydess IUS preferred over mirena?

A

in women you cant fit the mirena

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53
Q

Pearl index of copper IUD

A

0.5-2

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54
Q

When is the copper IUD contraindicated?

A

When there is ongoing bleeding, trophoblastic disease, recent delivery within the last 4 weeks, active PID

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55
Q

2 materials that condoms can be made from?

A

polyurethane or latex

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56
Q

What are female condoms made from?

A

Polyurethane

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57
Q

What does the female diaphragm lie between?

A

anterior pubic ramus to the posterior fornix

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58
Q

What is the failure rate of male sterilization

A

1/2000

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59
Q

What is the delayed effectiveness of male sterilization?

A

3-6 months

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60
Q

What is the failure rate of female sterilization?

A

1/250

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61
Q

During an ESSURE procedure what material is placed in the fallopian tubes (2)?

A

titianium and nickel

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62
Q

Which 2 STIs do not need sexual contact but only close contact in order to be spread?

A

Public lice and scabies

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63
Q

At risk groups of HIV?

A

Black/Afrocarribean, gay men, IV abusers, young adults

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64
Q

Sexual health history symptoms to ask about?

A

dysuria, dyspareunia, discharge, itch, pain/discomfort (superficial/deep), bleeding after sex or between periods, smell, rash, lesions

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65
Q

What specific extra STD tests do homosexual men recieve?

A

Hep b and c

66
Q

How is chlamydia vs gonorrhoea tested for in a laboratory?

A

C = PCR, G = gram stain microscopy

67
Q

5 Cs of a consultation?

A

Cure, Contact tracing, Condom, Complication, Chance to educate

68
Q

Questions to ask about discharge?

A

Amount, smell, blood, consistency

69
Q

BV symptoms?

A

very foul smelling discharge, minimal itch

70
Q

What happens to the vaginal bacteria in BV infection?

A

Lactobacilli are eradicated and replaced with anaerobes and some aerobes

71
Q

What are the 4 features of the AMSELs criteria in BV diagnosis and how many features are needed to diagnose?

A

pH over 4.5, amine test positive with KOH, appearance of discharge frothy and white, clue cells on microscopy

72
Q

What medication is given to treat BV? what does it do?

A

metronidazole to kill anaerobes and allow lactobaccilli to grow

73
Q

What is risk with BV infection in pregnancy?

A

PRoM

74
Q

Presentation of vaginal candidiasis?

A

Itchy, red, satellite lesions, discomfort, curdy discharge

75
Q

What topical treatment is available for candidiasis?

A

clotrimazole cream or pessary

76
Q

What oral treatment is available for candidiasis?

A

fluconazole or itraconazole

77
Q

Presentation of trichomonas?

A

Itch, discomfort, dyspareunia, discharge, acute vulvovaginitis

78
Q

Why are trichomonas infection presentation often named strawberry cervix?

A

punctate haemorrhages

79
Q

If punctate haemorrhages are seen on the cervix what infection do you suspect?

A

trichomonas

80
Q

Treatment of trichomonas infection?

A

Oral metronidazole

81
Q

Why do you have to use PCR/NAAT to diagnose chlamydia

A

cannot be seen on gram stain as an intracellular pathogen

82
Q

What 3 serovars of chlamydia are the leading cause of infectious blindness?

A

A b c

83
Q

What serovars of chlamydia are most common STis in the Uk

A

d/e/f/g/h/i/j/k

84
Q

Serovars L1/L2 and L3 of chlamydia lead to what? what does it invade?

A

lymphogranuloma venereum invading genital lymph nodes leading to inguinal syndrome or rectal syndrome

85
Q

Symptoms of chlamydia in women?

A

change in discharge, deep dysparunia, post coital bleeding, itch, PID, infertility, acute urethritis, proctitis, pelvic pain, ectopics, conjunctivitis, reactive arthritis

86
Q

Symptoms of chlamydia in men?

A

Urethritis, discharge, bleeding, epididymo-orchitis, proctitis, rectal involvement, conjunctivitis, reactive arthritis

87
Q

SARA? gained from what infection?

A

sexually acquired reactive arthritis usually from chlamydia

88
Q

3 symptoms of PID found on bimanual examination?

A

pelvic tenderness, cervical excitation, adnexal tenderness

89
Q

List some differentials of PID?

A

Ectopic pregnancies, endometriosis, UTI, ovarian cyst complications, acute appendicitis, IBD, diverticulitis, dka, Addisonian crisis

90
Q

Investigations into suspected PID?

A

Urinalysis and urine culture

91
Q

Treatment/management of PID?

A

antibiotics, fluids, analgesia, antipyrexial

92
Q

What is the identifying feature of non specific urethritis in men?

A

excess polymorphonuclear leukocytes (PMNLs) in anterior urethra

93
Q

What type of bacteria is gonorrhoea?

A

gramnegative diplococci

94
Q

Treatment of chlamydia?

A

Azithromycin 1g

95
Q

Gonorrhoea treatment?

A

Cefixime 400mg

96
Q

PID drug treatment ?

A

Ofoxacin 400mg BD and metronidazole 400mg BD

97
Q

What causes genital warts?

A

HPV

98
Q

2 most common benign HPV strains?

A

6 and 11

99
Q

Type of people you would be worried about HPV reoccurence?

A

Pregnant, immunocompromised or diabetic

100
Q

2 ablative methods of genital wart treatment?

A

Cryotherapy or electrocautery

101
Q

3 chemical methods of treating genital warts?

A

podophylotoxin, TCA (trichloracetic acid), imiquimod cream

102
Q

Most cervical cancers are caused by which 2 strains of HPV?

A

16 and 18

103
Q

Name of the HPV vaccine that protects against strains 16 and 18 only?

A

Cerovex

104
Q

Name of the HPV vaccine that protects against 6,11,16,18

A

Guardosil

105
Q

Molluscum contagiosum - describe, identifying feature, spread, treatment

A

smooth papules, umbilicated centre, skin contact, spontaneously regress

106
Q

How does herpes infection initially present?

A

Prodrome of flu, ulcer, tender inguinal nodes

107
Q

2 complications of herpes infection? (pain/obstruction)

A

post herpetic neuralgia, urinary retention

108
Q

First line treatment of herpes infection?

A

Aciclovir

109
Q

What trimester can herpes infection develop into neonatal herpes?

A

3rd trimester

110
Q

If someone presents with a solitary painless ulcer what are you concerned about? how would you test?

A

Primary syphilis, ulcer exudate shone under dark ground microscopy and repeat in 12 weeks

111
Q

2 potential complications of lichen sclerosis on the penis if left untreated?

A

Meatal stenosis and phimosis

112
Q

Complications of lichen sclerosis on the vulva?

A

Vulval stenosis, fusiolabia

113
Q

2 causative agents of pediculosis?

A

crabs or nits

114
Q

What is the treatment of pediculosis?

A

Malathione 0.5% over effected area

115
Q

What is it that causes itchy inflammatory reaction in scabies?

A

the excrement from the mites

116
Q

Treatment for scabies?

A

Malathione 0.5%

117
Q

If a baby is born to a HIV positive mother, what prophylactic treatment is given to the baby?

A

4 weeks of ART

118
Q

Presentation of primary syphillis and how long after infection does it present?

A

2-6 weeks with a painless ulcer

119
Q

How does secondary syphilis present?

A

generalised rash on body, arms and palms, lymphadenopathy, aseptic meningitis, transient hepatitis or cranial nerve palsy

120
Q

Causative agent of syphilis? identified with what light?

A

Treponema pallidum, dark ground microscopy

121
Q

What are the tests available for treponema infection?

A

serological treponema animo assay or treponema pallidum particle agglutination (TPPA)

122
Q

What are VDLR tests useful for in syphilis?

A

Monitoring treatment response

123
Q

3 systems that are mainly invovled in 3rd stage syphilis?

A

eyes, neuro, CV

124
Q

What is done to prevent Hep B being transmitted from mother to baby?

A

Hep B specific immunoglobulins and vaccine to baby

125
Q

Risk factors for erectile dysfunction?

A

older age, hypertension, heart disease, dyslipidaemia, less physical exercise, diabetes, neuro disorders, radiotherapy, trauma,

126
Q

What are the 2 main classes of medications that can cause erectile dysfunction?

A

antihypertensives, antidepressants

127
Q

What are 3 baseline blood tests for erectile dysfunction?

A

Lipid levels, testosterone, fasting glucose

128
Q

What drug class is used for erectile dysfunction?

A

PDE5 inhibitors

129
Q

Example of PDE5 inhibitors

A

sildenafil (viagra), tadalafil (cialis), vardenafil (levitra)

130
Q

What type of contraception is nexplanon?

A

subdermal implant

131
Q

How often do you get the depo provera contraception?

A

Injected every 12 weeks

132
Q

3 strengths of oestradiol in the cOCP?

A

20/30/35 mcgs

133
Q

Safety window for taking the cOCP?

A

12 hours

134
Q

Miss a cOCP how long does it take to get back up to full coverage?

A

7 days

135
Q

SE of the cOCP?

A

low mood, headache, tiredness, nausea, bloating, acne

136
Q

Contraindications to the cOCP

A

BMI over 35, smoker aged over 35, focal migraines, uncontrolled hypertension, liver problems, breast cancer presently or last 5 years, trophoblastic disease

137
Q

What is contained within EVRA and what dosage?

A

progesterone and 20mcgs of oestrogen

138
Q

How much oestrogen is contained within NUVARING?

A

15 mcgs

139
Q

How long does it take to return POP to a normal level after missing a dose?

A

2 days

140
Q

What is the safety window of the POP?

A

3 hours

141
Q

How does POP work?

A

Makes cervical mucus thicker to stop sperm passing through

142
Q

Side effects of POP?

A

headache, low mood, acne, loss of libido

143
Q

How does Levonelle prevent pregnancy?

A

Delays the LH surge and therefore ovulation by up to 5 days until sperm dies

144
Q

What situation will Levonelle be ineffective?

A

Any one who has been on contraception in the last 5 days

145
Q

How does EllaOne act to prevent pregnancy?

A

Progesterone receptor competitor which acts to prevent follicular stimulation and growth

146
Q

Emergency contraception is ineffective if the patient is taking what 2 medications?

A

PPI, steroids

147
Q

When in the cycle can Cu IUD be fitted?

A

5 days after the earliest potential ovulation

148
Q

When is a uterus not suited for Copper coil insertion?

A

if it is distorted by fibroids etc

149
Q

Why is Desogestrol different to other POP?

A

has a 12 hour window instead of a 3 hours window and takes 7 days to return to normal cycle after missing a dose unlike other progesterones which only take 2

150
Q

Which contraceptive method leads to nearly all women being amenorrhoeic within 3 months?

A

Depo Provera

151
Q

Major potential side effect of Depo Provera?

A

Decreased bone mineral density

152
Q

How long does it take to regain fertility after stopping depo provera?

A

up to a year

153
Q

What disease makes Copper IUD contraindicated?

A

Wilson’s Disease

154
Q

How long does mirena and jaydess last?

A

mirena for 3 years, jaydess for 5 years

155
Q

How does mirena effect HRT dosing?

A

Mirena provides progesterone therefore only need to take oestrogen

156
Q

What is needed to be used with the diaphragm method of contraception?

A

Spermicide

157
Q

In male sterilization when is the first sperm sample taken post op? when is the second taken?

A

First after 2 weeks post op then second after 3 months

158
Q

What is the Essure method of sterilization in women?

A

LA, springs in isthmus, fibrosis, occlusion

159
Q

When taking a contraception consultation what is it important to ask about in the medical history?

A

Migraines, DVTs, breast cancer in the last 5 years, any illnesses

160
Q

What is it important to ask about in a contraception clinic history?

A

medical history, contraceptive needs, choices, gynae history, obstetric history, sexual history, drug and allergy history, FH of DVTs or breast cancer,

161
Q

What must you explain about each contraceptive method?

A

What it is, failure rate, how to take it, SE, risks, benefits, informed choice

162
Q

What 3 tests and examinations are needed before starting on contraception (pills specifically)

A

BMI, BP, smear

Obs and Gynae (27 decks)

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