Questions

Question 1

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Answer 1

These are vulval papillae. It is a normal anatomical variant. Please leave this alone!

Question 2

Bacterial vaginosis in pregnancy is associated with an increased risk of [2]

Answer 2

Bacterial vaginosis in pregnancy is associated with an increased risk of preterm rupture of membranes and premature labour

Question 3

What advise should you give patients about avoiding sex if you suspect they have herpes [2]

Answer 3

The key piece of advice that needs to be given is that sex should be avoided when there is a prodrome and or genital lesions are present.

Question 4

Choroidal granulomas,

Question 5

Answer 5

This is Trichomonas

Question 6

Kaposi’s sarcoma is strongly associated with HHV-[]

Answer 6

HHV-8

Question 7

A patient is HIV +ve

A whole brain CT scan is requested. The report states:
There is a single lobulated lesion in the left frontal lobe, with solid homogenous enhancement. There is involvement of both the periventricular area and the caudate.

What is the diagnosis? [1]
What is the treatment? [1]

Answer 7

Primary CNS lymphoma
- This is due to the progressive nature of the presentation, and the report of a single lobulated lesion with single homogenous enhancement
- In this case, cART is indicated along with whole brain irradiation

Question 8

What is the most appropriate test to provide this patient with an accurate diagnosis?

Rapid point of care test

Viral load

Viral PCR

4th generation Antigen and antibody test

CD4 count

Answer 8

4th generation Antigen and antibody test
- covers 45 days

Question 9

HIV dx.
A CT scan followed by an MRI as an inpatient which demonstrated multiple ring-enhancing lesions in the basal ganglia.

Dx? [1]
Tx? [2]

Answer 9

• Dx: cerebral toxoplasmosis
• Tx: Pyrimethamine and sulphadiazine

Textbooks often present the picture that patients with CNS lymphoma are more likely to have one lesion visible contrasting with multiple lesions in toxoplasmosis

Question 10

HIV Dx
Patient has epithelial keratitis.
What are they likely to be infected with? [1]

Answer 10

The epithelial keratitis is a hallmark finding of HSV ocular infection.

Question 11

Which of the following is an example of an AIDS-defining illness?

Oesophageal candidiasis

Pityriasis rosea

Herpes Simplex Virus (HSV) encephalitis

Bilateral bacterial conjunctivitis

Pseudomonas aeruginosa pneumonia

Answer 11

Which of the following is an example of an AIDS-defining illness?

Oesophageal candidiasis

Pityriasis rosea

Herpes Simplex Virus (HSV) encephalitis

Bilateral bacterial conjunctivitis

Pseudomonas aeruginosa pneumonia

Question 12

You see an anxious 22 year old women in GP who wants to get tested for HIV. She has recently found out that a person she had sex with 3 months ago is HIV positive. They didn’t use any barrier contraception. She has had two flu-like illnesses since the exposure, 2 months and 2 weeks ago.
Which blood test should you perform to check her HIV status?

P24 Antigen test

HIV Antibody test

Blood film light microscopy

Nucleic Acid Test (NAT)

CD4 count

Answer 12

You see an anxious 22 year old women in GP who wants to get tested for HIV. She has recently found out that a person she had sex with 3 months ago is HIV positive. They didn’t use any barrier contraception. She has had two flu-like illnesses since the exposure, 2 months and 2 weeks ago.
Which blood test should you perform to check her HIV status?

P24 Antigen test
- Anyone concerned about an exposure can be tested from 1-4 weeks afterwards, using this method. This patient was exposed 3 months ago so a p24 antigen test would be negative even if she had the infection.

HIV Antibody test
- Antibodies can be identified from 4 weeks after infection and are 99% sensitivity by 3 months. After an initial positive, the test should be repeated 12 weeks after.

Blood film light microscopy

Nucleic Acid Test (NAT)

CD4 count

Question 13

What are notable side effects of co-trimoxazole treatment? [3]

Answer 13

SJS/TEN
Drug induced lupus
Agranulocytosis

Question 14

How do you determine if you should rec. a normal vaginal or C section for a pregnant person? [2]

Answer 14

If the mother’s viral load is < 50, a normal vaginal delivery can be recommended and supported.

If the viral load is greater than 50, an elective caesarean section is recommended

Question 15

A 48 year old man is brought to A&E. He struggles to articulate, but tells you that he woke up this morning with right sided weakness.
He has been taking cART for the past 10 years.
Given the clinical picture, what is the most likely diagnosis?

Left sided middle cerebral artery infarct

Meningitis

Progressive multifocal leucoencephalopathy

Toxoplasmosis

Right sided middle cerebral artery infarct

Answer 15

Left sided middle cerebral artery infarct
- Patients with HIV on long term cART are at a significantly increased risk of both ischaemic and haemorrhagic stroke

Question 16

HIV positive patient with a raised opening pressure on lumbar puncture is most likely to be suffering from what pathology? [1]

Answer 16

cryptococcal meningitis

A raised opening pressure on lumbar puncture in HIV positive patients with neurological symptoms may indicate cryptococcal meningitis, although normal CSF findings are possible.

Question 17

Name a hormonal cause for an increased risk of thrush [1[

Answer 17

A key risk factor for candidiasis is combined oral contraceptive use. Oestrogen in the pill can alter the vaginal environment, making it more conducive for fungal growth.

Question 18

Vaginal swabs were taken and showed squamous epithelial cells coated with large amounts of bacilli.

Dx? [1]

Answer 18

bacterial vaginosis (BV)
- caused by a reduction of lactobacilli in the vaginal flora and an overproduction of mainly anaerobic organisms, the most common of which is Gardnerella vaginalis

Question 19

persistent itching and ulcerated lump on the vulva

Most likely dx? [1]

Answer 19

Vulval cancer

Question 20

Male patient has white penile discharge.

How do you determine what an infection may be based off a smear?

Answer 20

If a smear displays 5 or more polymorphs per high power field, with no evidence of gram negative diplococci: most likely chlamydia infection

Question 21

Syphilis and LGV both present with painless ulcers.

Which other clinical features would help determine the difference between them? [1]

Answer 21

LGV
- followed by painful inguinal lymphadenopathy.

Syphilis:
- presents with a painless chancre at the site of infection but not inguinal lymphadenopathy.

Question 22

A GP suspects a diagnosis of pelvic inflammatory disease (PID).

What antibiotics should be prescribed for this patient? [3]

Answer 22

Intramuscular ceftriaxone, oral doxycycline and oral metronidazole

Question 23

How do endometrial and ovarian cancers differ in their presentations? [2]

Answer 23

Postmenopausal bleeding is more indicative of endometrial cancer.

Ovarian cancer typically presents with abdominal distension, early satiety or loss of appetite, pelvic or abdominal pain or urinary urgency or frequency, particularly in women aged >50 years old

Question 24

Gonorrhoea treatment if patient is allergic to ceftriaxone? [2]

Answer 24

Intramuscular gentamicin and oral azithromycin
- In patients with a history of severe hypersensitivity reactions (such as anaphylaxis) to penicillin or other beta-lactams, ceftriaxone should be avoided.

Question 25

Describe what how vaginal ultrasound can inform you with regards to endometrial cancer [1]

Answer 25

Ultrasound would suggest an abnormality if the lining was thickened (normally it thins after menopause) or if the thickness is not uniform.
- If the endometrial thickness is less than 5mm uniformly then the risk of endometrial cancer is less than 1%

Question 26

Uniform, endometrial lining < 2mm in thickness is most likely to be what diagnosis? [1]

Answer 26

Atrophic vaginitis, also known as vulvovaginal atrophy, is a condition characterised by inflammation and thinning of genital tissues due to reduced oestrogen levels

Question 27

On microscopy, [] bacteria are classically flagellated unicellular organisms

Answer 27

On microscopy, Trichomonas bacteria are classically flagellated unicellular organisms

Question 28

What medication (and dose) do you give for uncomplicated [1] and recurrent thrush [2]

Answer 28

Uncomplicated thrush:
- Fluconazole oral capsule 150mg as a single dose

Recurrent thrush:
* Induction with Fluconazole oral capsule 150mg every 72 hours for a total of three doses
* Maintainence with Fluconazole oral capsule 150mg once weekly for six months

Question 29

How do you treat thrush in pregnancy? [2]

Answer 29

intravaginal antifungal agent such as a Clotrimazole pessary +/- a topical antifungal cream e.g. Clotrimazole.