Passmed

Question 1

Candida full name + Symptoms

Answer 1

Candida albicans

Cottage white discharge
Non smelly discharge
Itchiness

Vulvitis - superficial dyspareunia, dysuria

Sometimes also:
-fissures
-satellite lesions

Question 2

Investigation + management for Candida albicans

Answer 2

No investigations needed unless 4 episodes of thrush a year. Check for diabetes / immunosuppression and how creams are used.

Management - oral fluconazole, clotrimazole pessary.

Question 3

How do you manage Candida if there is also vulvitis?

Answer 3

Consider topical IMIDAZOLE

Question 4

If someone is pregnant and has Candida, how do you treat?

Answer 4

Topical stuff only, oral fluconazole is contraindicated.

Question 5

What do you have to exclude if someone has recurrent vaginal candidiasis? How do you manage?

Answer 5

compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus

Question 6

How would you manage recurrent vaginal candidiasis?

Answer 6

consider the use of an induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

Question 7

Cellulitis, pregnant - Mx?

What would you give if not pregnant?

If no penicillin allergy?

Answer 7

Erythromycin first line if pregnant

Fluclox first line if not pregnant.

If penicillin allergy: Doxy, Erythro or Clarithryo

Question 8

Criteria for considering admission with cellulitis

Answer 8

Eron classification - 3-4 = admission for IV Antibiotics.

3+ systemically unwell

Question 9

Main complication with UTI

Answer 9

pyelonephritis

Question 10

Mx for UTI if not pregnant

Answer 10

Nitrofurantoin or Trimethoprim for 3 days

+ consider sending for urine culture

Question 11

When would you send a urine culture in someone with a UTI?

Answer 11

If there is visible or non visible haematuria, or if aged over 65 years

Question 12

UTI in pregnancy, Mx - first line, second line, what to avoid near term.

Answer 12

ALWAYS send urine culture
Treat with:

First line - Nitrofurantoin (but avoid near term)
Second line - Amoxicillin

Question 13

Ab to avoid in pregnancy UTI

Answer 13

Trimethoprim - especially awful in first trimester

Question 14

Contraindications for COCP - UKMEC 3

Answer 14

Wheelchair use / immobility
Regular smoking under 15 cigs if over 35
Carrier of known gene mutations e.g. Breast ca BRCA 1/2
Current gallbladder disease
Controlled HTN
FH of thromboembolic disease in someone under 45
BMI over 35

Question 15

ukmec 4

Answer 15

Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
long surgery
positive antiphospholipid antibodies e.g. SLE