Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DipGUM > OSCE > Flashcards

OSCE Flashcards

1
Q

24 yo woman HIV positive on HAART has a friend with cervical cancer. She asks you about cervical cancer and how it is detected.
Explain cervical screening, cervical cancer & CIN in HIV.

A

Discuss
- what causes cervical precancerous and cancerous changes & why is it important to diagnose
- how is CIN different in HIV positive women
- how is cervical cancer different in HIV
- how will she be screened and how often?
HPV 16, 18, 33
Easier to manage as CIN, reduces progression to cancer
CIN/cancer more aggressive in HIV +ve
Annual smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
30 yo African woman with recent diagnosis HIV (not yet   on HAART) has now been diagnosed with hepatitis B. She describes feeling unwell and looking a funny colour (jaundiced) 8 months ago.
HB cAb +ve
HB sAg +ve
HB eAg -ve/eAb +ve
HDV -ve
ALT 20
HBV DNA PCR >2000 copies
CD4 count 400 VL 12 000

Discuss results and diagnosis
Explain treatment

A

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

30 year old man requests PEPSE.

Take a relevant history and be prepared to discuss the management of his case.

A

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

28 yo man asks for advice about the risk of herpes for his regular female partner. They wish to have a baby. He has previously been diagnosed with HSV 2 PCR confirmed.
He requests aciclovir for suppressive therapy. Discuss management with him.

A

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
40 yo MSM returns to clinic for his recent routine sexual health screen results. He last had a test 1 year ago. He has had 6 casual male partners in the past 3 months. His results are:
rectal NAAT GC/CT -ve
throat NAAT GC/CT -v
urethral NAAT GC/CT -ve
syphilis negative
HIV positive
Explain his results to him
Discuss management
A

Discuss
HIV new diagnosis
Breaking bad news

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

19 yo male in his first year at University, has had his first sexual encounter with a male friend. He requests advice on safe sex practices. (or maybe attends for routine sexual health screen)
Explain a routine sexual health screen
Discuss safe sex practices
Manage any further Qs

A 
Point of this Q - MSM sexual health
- testing - what/timing/window periods
- condoms + lube
- PEP/PrEP
- vaccines
- risk behaviour counselling
Discuss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

15 yo woman requests emergency contraception.
Take focussed history
Explain emergency contraception
Manage any further Qs

A

Discuss

- offer all options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

20 yo woman requests the morning after pill.
Take a history
Deal with her specific request
Manage any further Qs

A

Discuss

- wants pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A 23 yo MSM attends with 3 days urethral discharge. He last had oral sex only with a casual male partner 7 days ago.
Describe how to perform a microscopy slide (urethral smear and gram stain)
Perform microscopy

A

Take through micro process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A 23 yo MSM attends with 3 days urethral discharge. He last had oral sex only with a casual male partner 7 days ago. Microscopy show PMNLs >5/high power field in >5 fields and intracellular GNDC.
Explain the diagnosis
Explain the management
Manage any further Qs

A

Gonorrhoea in MSM

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

You are the acute GUM registrar. You are asked to review a 29 yo man in A&E requesting PEPSE.
Take a history
Discuss management

A

Discuss

[RMP last sex 5/7 ago; CMP via Grindr 5am UOI, UIAI and URAI; no other partner past 3/12; RMP HIV +ve VL<40; no PMH/med/allery; last SHS January]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

31 yo heterosexual man attends the walk in GUM clinic. He has 5/7 history of dysuria.
Take a history
Discuss investigation and management plan
Manage any further Qs

A

Discuss

[last sex RFP 1/7 ago; other sex with CFP 2 weeks ago]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

31 yo heterosexual man attends the walk in GUM clinic. He has 5/7 history of dysuria.
Take a history
Discuss investigation and management plan
Manage any further Qs

A

Discuss

  • assessment for urethritis
  • management plan
  • future sexual health
  • partner notification (non-complex)

[last sex RFP 1/7 ago; other sex with CFP 2 weeks ago]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
27 yo MSM presents with an ulcer of his foreskin. It is slightly tender and has increased in size.
Take a history
Perform microscopy 
Explain management
Manage any further Qs
A

Discuss

  • syphilis case
  • dark ground micro

[painful ulcer 3/7, growing; sex CMP online 2/7 ago PAI and UOI; last other sex 1/52 ago at a sex party; 40 partners in 3/12]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
27 yo MSM presents with an ulcer of his foreskin. It is slightly tender and has increased in size.
Take a history
Perform microscopy 
Explain management
Manage any further Qs
A

Discuss

  • syphilis case (aim hx in 4min)
  • dark ground micro

[painful ulcer 3/7, growing; sex CMP online 2/7 ago PAI and UOI; last other sex 1/52 ago at a sex party; 40 partners in 3/12]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

30 male attends GUM clinic with lumps on the foreskin, On examination you identify warty lesions and diagnose HPV genital warts.
Explain diagnosis
Explain management plan
Manage any further Qs

A

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Holly 16 yo female attends for a routine sexual health screen. She takes the oral contraceptive pill.
Take a history
Explain management plan
manage any further Qs

A

Discuss

  • general history inc risk assessment
  • check pill adherence/offer LARC; aware of EC and missed pill plan
  • explain NAAT (self swab) and bloods
  • PT/condoms/HA

Risk assess

  • whose at home/relationship
  • friends
  • how does she know sexual partner
  • age of sexual partner
  • place of sex
  • first age of sex
  • who does she talk to about sex/partners
  • check coercion - money/drugs/Etoh/food/gifts
  • education/work
  • social worker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q 
Simon 35 yo man attends clinic for his recent sexual health screen. He feels well. Results:
HCV +ve
HCV RNA > 2000 000
STS -ve
HIV -ve
HBsAb +ve
CT/GC -ve
ALT 121
Explain results 
Take a history
Explain management plan
A

Discuss
Hx - risk assess
Dx - treatable; spontaneous clearance small number
Mx - repeat VL 4/52 and check genotype; refer to HepC specialist team; liver US; PN; reduce EToH intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Thomas 31 yo man request PrEP
Take a relevant history
Provide relevant information on PrEP
Manage any further Qs

A

Discuss
Hx - general MSM and risk assess for PrEP benefit:risk
Info - self sourcing vs NHS; PrEP (tenofovir disoproxil and emtricitibine); mechanism of action; name trials; risks renal and bone; dosing; starting/stopping; side effects; tests and follow up
Offer HA etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

30 yo Maria from Romania has been referred to you to discuss her recent results. She is 20 weeks pregnant and has routine perinatal screening.
syphilis +ve (need some serology examples)
HIV -ve
Explain results
Discuss management
manage any further Qs

A

Discuss

high RPR - likely early
low RPR - likely late latent

check other children
treat partner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

25 yo woman complains of change in vaginal discharge and vulval irritation. You perform a vaginal examination and take swabs for microscopy
Take a brief history
Perform examination +/- describe swab technique

A

Discuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

27 yo pregnant woman attends with history of recent partner diagnosed with trichomonas vaginalis. She has some vaginal discharge. She is 16 weeks pregnant.
Take a brief history
Explain management
Manage any further Qs

A

Discuss

- TV in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

24 yr old pregnant woman presents with change in discharge. Thin and watery with a fishy smell.
You perform a high vaginal swab.
Perform microscopy
Explain diagnosis and management

A

Discuss
Micro - BV (4-5 min)
Dx and Mx (5-6min)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

26 yo woman presents with painful lesions on vulva.
Take a history
Explain investigation and management
Manage any further Qs

A

Discuss

- herpes case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

26 yo woman presents with painful lesions on vulva. She feels generally under the weather with swollen tender lymph nodes in the groin. On examination she has multiple shallow ulcers and a few vesicular lesions on bilateral labia.
Explain diagnosis, investigation and management
Manage any further Qs

A

Discuss

- herpes case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

21 yr old woman presents with post coital bleeding and pelvic pain worse during sex.
Take detailed history
Explain management
Manage any further Qs

A

Discuss

  • PID case
  • exclude cervical pathology and pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q 
30 yo MSM attends for his results.
HBsAg +ve
HBV DNA 5000
Take a brief history
Explain diagnosis and management
Manage any further Qs
A

Discuss

28
Q 
John 24 yo MSM attends for results.
HIV -ve
STS -ve
NAAT GC/CT -ve
HCV Ab +ve
HCV PCR 10 000 copies
ALT 54
Explain diagnosis and management plan
Manage any further Qs
A

Discuss

29
Q

35 yo man has itchy genital lesions.
Take a history
Explain management plan
Manage any further Qs

A

Scabies

[2/52 itchy red lumps, waking up at night, wrists affected too; changes soaps etc all the time; no skin issues; CFP UPSI 2/52 ago]

30
Q

John 25 yo man HIV +ve not on treatment. Attends clinic and complains he is unwell.
Take a history
Briefly explain management
Manage any further Qs

A

SOB + HIV case

[SOB 2/52, cough slight, 1 flight of stairs; smoker; CD4 low]

31
Q

James 26 yo man sexually assaulted 36 hours ago.
Take a history
Discuss management
manage any further Qs

A

MSM + sexual assault

- split history/explanation 50:50

32
Q

Rhonda 30 yo 12 weeks pregnant black African woman attends for results.
HIV +ve
Explain results
Explain management

A

Discuss

- include brief history to establish PN, children, timing of infection

33
Q

Fraser 22 yo MSM request HIV POCT and routine sexual health screen.
Take a brief history
Discuss POCT
Discuss further management

A

Discuss

  • HIV risk assess
  • Serology needed and follow up results plan
34
Q

40 yo Mary from Zimbabwe has been referred by her GP following an HIV test. Her husband died 5 years ago and she has been seeing her GP recently for menorrhagia.
HIV +ve
Explain diagnosis and management
Manage any further Qs

A

Discuss
(likely husband HIV +ve)
- children

35
Q

18 yo woman attends sexually assaulted last night.
Take a history
Discuss management
manage any further Qs

A

Discuss

- split history/explanation 50:50

36
Q

32 yo MSM attends with widespread rash, lymphadenopathy and headache and slight change in his hearing on left side. His POCT reactive for syphilis.
Explain diagnosis and further investigation
Explain management
Manage any further Qs

A

Discuss
- neurosyphilis

REMEMBER JH and STEROIDS

37
Q

32 yo MSM attends with widespread rash, lymphadenopathy and has recently heard a partner is positive for syphilis.
Take a brief history
Explain diagnosis and management
Manage any further Qs

A

Discuss
- secondary syphilis (no other symptoms)

REMEMBER JH

38
Q

22 yo transgender woman (male to female) on HRT and awaiting transition surgery attends clinic and requests sexual health screen.
Take history
Discuss relevant risk reduction strategies

A

Discuss

  • check pronouns
  • offer full screen
  • consider HepB vaccine and HPV
  • what meds interact with HRT???
39
Q

15 yo girl referred to you by health advisor who is concerned about her safety.
Take a history
Explain safeguarding process

[establish 20 yo RMP who is forcing her to have sex with his friends]

A

Discuss

  • confidentiality
  • risk assess inc Fraser guidelines
  • discuss STI testing
  • explain safeguarding/referral process
  • follow up
40
Q

25 yo woman attends with recurrent heavy smelly discharge. She has a CuIUD in situ and a RMP of 2 years.
Perform microscopy on HVS sample
Explain diagnosis and treatment to patient

[BV - on micro slide or picture]

A

Discuss

41
Q

21 yo MSM requests a STI screen. He has had a recent flu like illness.
Take a sexual history

A

Discuss

  • include need for HIV and if history consistent with seroconversion illness explain this
  • will need follow up plan for results
  • explain window periods
42
Q

22 yo woman requests emergency contraception.
Take a history
Counsel on treatment options and future contraception

A

Discuss

- EC history inc contraceptive Hx

43
Q 
23 yo Chinese man attends for discussion of his results.
Recent:
HBsAg +ve
HBcAb +ve
HBeAg -ve
HBeAb +ve
HBsAb 0
6 months before:
HBsAg +ve
HBcAb +ve
HBeAg +ve
HBeAb +ve

Perform an abdominal exam and discuss further management

A

Discuss

  • abdo exam
  • check HBV DNA viral load and LFTs, and screen for other BBV, refer to hepatology and will need US liver and AFP(?) and will consider if treatment indicated
  • stop alcohol
  • partner notification
  • household contacts and need for vaccine
  • avoid use of razors/toothbrushes
44
Q

36 yo MSM requests routine STI screen. He has had multiple CMPs in past 3 months and uses chems every weekend.
Discuss risk reduction strategies

A

Discuss

45
Q

30 yo woman is 26 weeks pregnant has been diagnosed with trichomonas vaginalis.
Explain diagnosis
Discuss management
Address any concerns

A

Discuss

[complications of TV? risk of metronidazole to pregnancy?]

46
Q

64 yo man has a rash on his penis. On examination ther is polygonal purple lesions on the glans.
[Lichen planus - shown picture)
Discuss management

A

Discuss

  • skin care
  • ??steroid
  • when to biopsy
  • follow up
  • safety net
47
Q

you are seeing John who is 45yo. He is an MSM who has had several casual partners in the last 2 months with UPAI. Last 5 days ago. He has noticed some urethral discharge the last few days and some aching in his right testicle this morning.
Please demonstrate male genital examination including testicular exam and talk to the examiner as you go along (no need for proctoscopy). The examiner will show you the results of the examination. Please advice him on further management. You do not need to take further sexual history.

Patient hx:
John. 45 yo MSM.Lost of partners every weekend in sauna. You are on PrEP. You don’t use condoms, you loose your erection. You have had syphilis x2, gonorrhoea x2 before and Chlamydia x1. You have had Hep/B vaccinations and are immune. You have a penicillin allergy – with a rash. You drink a bottle of wine/week, you smoke 15/day and take chems (G,T,Miauw) and you slam. You have not had sober sex for 2 years. You work as a cleaner in the evenings and spend a lot of the day sleeping.

[Slide - PMNLs with GNDC; Picture - swollen erythematous right testicle]

A

Discuss

  • male examination include blue loop smear
  • explain urethral discharge
  • explain EO
  • follow up plan
48
Q

You are seeing Eva. She is 34 and has pain and discharge from her anus.
Please take a history and perform proctoscopy. The examiner will tell you when 5 min have gone so you can start the examination. After the examination the examiner will show you a picture and please explain to Eva how she will be managed.

Patient hx:
Eva 34 Ukranian sex worker. You have several client a day and usually come to the clinic often. You are usually very careful but this client paid you a lot of money to have UPAI 5 days ago – you went for PEP in the local sexual health clinic the day after and have had it before with no problem. You are immune to Hep B. You smoke 20/day. No alcohol/drugs. You have 2 children and you are a single mum. You have a copper IUD. There is no sexual assault but you have been raped in the past, you have a pimp and work out of a brothel mainly. You feel fairly safe in your work. You don’t want PrEP as normally use condoms and mainly vaginal sex. No medical history or allegies.

[Slide PMNLs +++]

A

Discuss

  • explain proctitis
  • risk reduction strategies
  • STI screen
  • Rx - ABx + aciclovir?
  • PN
  • HA/PIL/safety guidance
49
Q

You are working in the GUM clinic. Martin has noticed a rash on his penis.
please perform a full examination of his skin (excluding the genitals) and then look at the pictures from the examiner? Explain the diagnosis and management to the patient.

A

Discuss

  • Full derm exam - state would include genitals
  • complete exam with dermatoscope of suspicious lesions and relevant systems exam
50
Q

You are seeing Freddy who is 24 yo and has come in complaining about a rash on his penis. The nurse has seen him . He has has an red, rash which is a bit itchy on his penis for 10 days now. Ad it is not going away. He has a regular girlfriend for 4 years, they have regular sex last 4 days ago O/V/A sex. No condoms. No other sexual partners recently but male partners last month. She is asymptomatic.
You examine him and this is what you see. Please let him know how you will investigate and manage him? There is no need to take a detailed sexual history.

Patient hx:
You are Freddy 24. You have an itchy rash which is a bit itchy, red and swollen. You have had it for the last 10 days and you have washed it but it is not going away. You are desperate for some treatment. You are otherwise well, no skin problems, never had similar. You have not tried anything for it. You use bar soap to wash. Girlfriend for 4 years, no other sexual partners and she is well; she may have had thrush in the past. You smoke 15/day.

[Picture of red swollen prepuce and glans, non-specific ulceration and desquamation of glans and prepuce

A

Discuss

- non-specific balanitis MSM

51
Q

You are seeing Amir who is 15yo boy who has come in requesting condoms and a c-card.
Please take a history and provide him with condoms if indicated.

Patient hx: you are Amir and you are 15. You want condoms as you are thinking about having sex with your girlfriend who you have been going out with for 1 month. She is 15yo as well and you go to school together (she is not on contraception…if asked). You have never had sex before and you don’t know how to use a condom but you remember it being mentioned at school. You don’t want to tell your parents as they do not believe in sex before marriage but you are likely to go on and have sex anyway. You are otherwise well and happy at school. Lots of friends. No sexting. You watch porn and boys at school have started having sex. No family social worker. You have tried smoking but do not like it. You drink at parties and take no drugs.

A

Discuss

  • risk assess + Fraser guidelines
  • Condom demo
  • other contraception
  • SHS in future
  • HA/PIL/offer to see partner
52
Q

You are seeing Paddy who is 29 and has come in complaining of pain in his testicles.
Please take a history and manage him appropriately

Patient hx: you are Paddy and you are 29yo. You have had painful testicles for 3 days now.Started gradually. The pain is mainly on the right side – dull ache. Hurts more to be touched or you bang them. Helped with some paracetamol. You had some burning when you passed urine 1 week ago. Last sex 3 weeks ago with a casual female partner, O/V, no condoms.Sex before that with regular partner for 2 years, 1 month ago O/V – no condoms as she is on the pill. You have had chlamydia in the past. No other medical problems, penicillin allergy with a rash. You smoke 10/day, drink 20 units of alcohol/week, no drugs.

[picture: swollen shiny red scrotum right side]

A

Discuss

  • EO
  • SHS
  • Rx
  • PN
  • follow up
53
Q

You are seeing Danny who is 25 and complaining of bloody discharge from his anus last 4 days.Some constipation and feeling of incomplete defecation. He is a 25yo MSM who has had UPAI 3 weeks ago.
Please perform proctoscopy explaining to the examiner and the patient throughout what you are doing and what samples you are taking. l
ook at the picture of the proctoscopyfindingd provided by the examiner afterwards and explain the diagnosis and management to Danny. You do not need to take a sexual history.

Patient hx: you are Danny 25yo and you have had bloody discharge the last 4 days. You have lots of sexual parters last 3 weeks ago. No condoms UPAI. You have had 9 partners last 3 months. Last HIV test 6 months ago. You take drugs – crystal and Miauw. You have injected before. No alcohol due to drugs, you smoke. You Have had HepB/A vaccinations. You have had PEP before and you cannot afford PrEP.

[Picture: patchy erythema and shallow ulceration of rectum]

A

Discuss

- proctitis

54
Q

You are seeing Janice who is 48 and has been complaining of intermenstrual bleeding for the last 3 months. You were examined before by a junior doctor who thought they could feel a mass and have asked for a review.Janice has a regular partner for 25 years and no other sexual partners. She has moved recently and has not registered with a GP yet and has not had a smear for over 3 years.
Please perform a smear test and bimanual examination and explain each step to Janice and the examiner as you go along.
Explain to Janice your findings, differential diagnosis and management. You do not need to take a sexual history.

Patient hx: You are Janice 48yo who have had IMB for 3 months. Your periods are very heavy for the past few years. You are not on contraception, you use condoms. You have missed your last smear because you have moved and have not yet registered with a GP. Your last smear was 4 years ago. Normal last smear and have always been normal. You smoke 20/day. You are worried you may have cancer as other doctor said they could feel a mass. You also want to know what will happen with the smear test results.

[Findings: fibroid uterus/normal smear]

A

Discuss

  • explain - smear and bimanual
  • explain diagnosis of likely fibroids
  • give differential
  • further Ix/Mx inc contraception
55
Q

You are seeing Rob who is 27yo. He has come In with a 4 days history of sores on his penis and the swab has come back for HSV 2. He is in a longterm relationship for 5 years and his last different sexual contact was 4 years ago with a casual female partner.
Please counsel him. You do not need to take a detailed sexual history.

Patient hx: You partner is pregnant 28 weeks and she has never had herpes or cold sores as far as you know. You are worried you have caught it from an ex casual partner 4 years ago when your current relationship was still new and not exclusive yet.

A

Discuss

56
Q

You are seeing Simon who is a 24yo msmwho has come in with 3 day hx of dysuria and and anal mucuoid discharge. He has multiple casual sexual partners in the last 2 months and lots of UPAI.
Please perform a male genital examination including urethral sampling and proctoscopy. You do not need to take a sexual history and you do not need to discuss PEP/PrEP. The examiner will show you the results from the sampling. Please manage the patient.

[Picture: gram stain of either PMNLs alone or PMNLs +GNDC}

A

Discuss

- GC/CT/NGU/proctitis treatment

57
Q

You are seeing Brenda who is 34. She recently had her 4th smear test done opportunistically in the department as she has recently moved to the area. She has a longterm boyfriend and a child of 4yo. All her smears have been normal to date. She is back for her results but have also noticed a bit of pink discharge after sex the last few days.
Please perform a speculum examination, female genital sampling and explain her the smear results: Mild dyskariosis; HPV +
You do not need to take a sexual history.

Patient hx: You have moved to the area recently and was out of date with your smear. Have a regular partner for 8 years and a son who is 4yo. You are not on contraception. You smoke 20/day. You are worried the results means you have cancer as you have been bleeding? How soon after do you need smear tests again? Can you have the HPV vaccine?

[After examination examiner tells candidate the microscopy findings are totally normal.]

A

Discuss

  • I think sampling for infection is suggested
  • order of sampling if doing swabs and smear - smear first (?) then lateral wall –> posterior fornix/high vaginal swab –> cervical slide
58
Q

You are seeing Lewis who is 42. He has been referred to you from his GP. He went to the GP for routine sexual health screen as he is going to donate sperm for IVF and surrogacy as his wife had a hysterectomy due to bad fibroids and you want a second child. The screen revealed syphilis serology EIA+, VDRL 1:8. He is a British man but has been in a longterm relationship for 10 years with a female partner and has 1 child who is 7. His GP has also recently started him on Ramipril for high bloodpressure.
Please perform a cardiovascular examination and explain your findings and the results of the syphilis serology and management to the patient.

Patient hx: You have a wife of 15 years and no other sexual partners. You are born in the UK and you have had male partners in your youth including UPAI. You have no other health problems or symptoms. No medications or allergies. No smoking, alcohol or drugs. Your wife would have had syphilis testing in pregnancy 7 years ago. You want to know if you can donate sperm? Will it have any long term consequences?

[Normal examination findings]

A

Discuss

- late latent syphilis

59
Q

You are seeing Alice who is 32 weeks pregnant and has seen her midwife as she had ulcers on her vulva. The Midwife has referred her urgently as it has shown HSV2.
Please counsel her.

Patient hx: Alice 32 weeks pregnant in first pregnancy. You had sores on the vulva last 2 days, felt unwell and burns when you pee. YOu went to see your midwife who took a swab and referred as potential genital herpes. The swab has come back HSV2 positive.

A

Discuss

60
Q

You are seeing Beverly who is 38 and has been seen 5 times in the last year with candida. On her results she has confirmed candida albicans on culture 3 times and she has partial response with treatment in between episode. She is back again with vaginal discharge. Please look at microscopy slide and show the examiner a field representative of her current pathology and counsel her accordingly.

Patient hx: You are Beverly, you are fed up. You have had this so many times. You have tried the pessary and you have tried the tablet and the problem seem to go away for abit but always comes back. This time you have had it for a week. (if asked it started after a course of antibiotics from you GP for chest infection) You have no medical problems. You had an HIV test a few months ago on routine screen. You have mild asthma and take Ventolin PRN. You have hayfever. Your mother has T2DM. Your periods are regular on COCP. You have no children but your partner and you would like to think about a child this coming year as you are getting on a bit. You are avoiding irritants, wash with soap substitute as you have been told and wear cotton underwear. You would be happy to go on suppressive treatment – would prefer a tablet. If counselled about risk to pregnancy happy to take pessary suppressive treatment.

[Slide: spore with hyphae]

A

Discuss

61
Q

You are seeing Alison who is 32 and 32 weeks pregnant. She has come in with lumps on her vagina. On examination she has genital warts.
Please explain the diagnosis and manage her accordingly.

Patient hx: You are Alison 32yo. 32 weeks pregnant in your second pregnancy. You have never had warts before. You have a husband of 7 years, no other sexual partners. You are concerned he may have cheated. What will happen to my baby. I want to get rid of them. You smoke normally – not in pregnancy.

A

Discuss

62
Q

You have been called urgently by nurse in HIV clinic to see Georgewho is 29yo Zimbabwean HIV+ man who has returned from visiting family in Zimbabwe. He has night sweats, weightloss and some haemoptysis. Please perform a respiratory examination and look at the CXR and answer any questions from the examiner.

[CXR: right UZ consolidation]

A

Discuss

  • resp exam
  • Mx - ABC, negative pressure and initial work up
  • TB treatment
  • ARVs and timing
63
Q

You are seeing Archie who is 37, street homeless and HIV positive from the clinic – He has not been seen for over a year in clinic and his last VL was 3000 and CD4 255. He has been admitted to AE with shortness of breath and the HIV specialist nurse has asked you to go see him.
Please perform a respiratory exam, interpret the bloodgas and explain to the patient how he will be managed.
ABG on air: Ph 7.39, PCO2 5.6, PO2 7.8, BE -1

A

Discuss

  • explain PCP inc complications
  • treat PCP
  • ARVs and timing
64
Q

You are seeing Julia who is 25yo. Her results have come back: Chlamydia Negative, Gonorrhoea Negative, HIV Abnegative, Syphilis EIA negative. Please let her know the results.

Patient hx: You are Julia. You are 25. You had sex 7 days ago with a casual male partner. UPSI (you have an implant). You also had sex 3 weeks ago with 2 black guys after a night out. You are worried about HIV.

A

Discuss

65
Q

You are seeing Amber who is a 27yo from South Africa. She has recently come to the UK with her family and has been found to be HIV+ on routine sexual health screen. Her VL is 1200, CD4 245 and she needs to start antiretrovirals with Truvada, Darunavir, Ritonavir.
Please counsel her.

Patient hx: You are Amber a 27yo heterosexual lady from South Africa. You did not know about your HIV status till last week when you got the results from a sexual health screen. They advised you to see the doctor today and that you will need to start antiretrovirals. You have no medical problems, take no regular prescribed medications but take some herbal remedies. You do not drink, smoke or take drugs. Periods normal, you have not had a smear test. You have boyfriend in SouthAfrica who is well as far as you know. You are on the COCP and have never been pregnant. You are worried about taking a tablet every day but more worried about getting sick. You want to know about giving HIV to others and to a potential baby in the future.

A

Discuss

  • benefits of ARV
  • risk of starting ARV
  • PM/D/allergy - include pharmacy
  • Social history DDI with rec drugs
  • Adherence
  • regular review/monitoring
  • disclosure and U=U
  • reproductive health
  • Explain ARVs - dosing, SEs, missed pills
66
Q

Your are seeing Kurt who is 35yo MSM. His tests results are back and HCcAb +. He has never had Hep C. Please perform an abdominal examination and counsel him appropriately.

Patient hx: You are Kurt. You have never had Hep C as far as you know. You last sti screen was over 5 years ago in Germany. You have no regular partner but go to the sauna once a month. You have mainly oral sex which is why you have not had an STI screen. You have no other medical problems, no medications or allergies. You drink wine most days, non smoker. You don’t take drugs anymore, you used to take a lot of dugs back In Germany and got hooked for a while on injecting crystal meth and did sex parties and sex clubs. You have been vaccinated against Hep B and A in the past.

A

Discuss

  • abdo exam
  • brief enquiry about HCV risks

DipGUM (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions