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ESA 4 > Repro 6 > Flashcards

Repro 6 Flashcards

1
Q

Nongonococcal causes of urethritis?

A

chlamydia trachomatis
ureaplasma
mycoplasma
trichomonas HSV

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2
Q

causes of genital ulcers?

A

HSV
syphilis
chanchroid

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3
Q

pregnancy related infections of pelvis?

A 
post-partum endometriosis
episiotomy infections
chorioamnionitis
puerperal ovarian vein thrombophlebitis- vein inflammation due to blood clot
osteomyelitis pubis
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4
Q

viral causes of orchitis?

A

mumps
coxsackie B

*coxsackie virus is resitant to gastric acid, along with polio, Hep A, and M.TB

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5
Q

what must be considered in difficulty determining method of diagnosis for chlamydia?

A

obligate IC bacteria so do not grow on routine lab media

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6
Q

infective form of chlamydia?

A

elementary body

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7
Q

what is salpingitis?

A

fallopian tube inflammation

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8
Q

most important causes of pelvic inflammatory disease in western world?

A

chlamydia trachomatis

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9
Q

major PID complication?

A

tubal damage, leading to infertility and ectopic pregnancy

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10
Q

most common neonatal infection due to cervical infection in pregnant women being source of chlamydia trachomatis?

A

neonatal conjuntivitis

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11
Q

what is pelvic inflammatory disease?

A

result of infection ascending from endocervix, causing endometritis, salpingitis, parmetritis, oophortis, tubo-ovarian abscess and/or pelvic peritonitis

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12
Q

2 organisms causative of PID?

A

chlamydia trachomatis

neisseria gonorrhoea

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13
Q

pathophysiology of PID?

A

infection ascends from endocervix and vagina into uterus, inflammation causes adhesions of mucosa to form ,and damage to tubal epithelium

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14
Q

behavioural RFs for PID?

A

sexual behaviour: multiple partners, unsafe sex
type of contraception used: intrauterine contraceptive device increases risk in 1st few wks of insertion
alcohol/drug use- more likely to have unsafe sex
cigarette smoking- immunocompro?*

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15
Q

contraception thought to be protective against symptomatic PID?

A

combined OCP

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16
Q

clinical features of PID?

A 
pyrexia
pain: bilateral lower abdominal tenderness
adnexal tenderness
cervical excitation
deep dyspareunia
abnormal vaginal/cervical discharge
abnormal vaginal bleeding
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17
Q

gyanecological causes of pelvic pain other than PID?

A

ectopic pregnancy- would do a preg test
endometriosis- history will be of cyclical pain- before periods, continuous pain in PID
complications of an ovarian cyst- tends to be unilateral ovarian involvement so unilateral pain

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18
Q

GI causes of pelvic pain?

A

acute appendicitis

irritable bowel syndrome

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19
Q

renal causes of pelvic pain?

A

UTI

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20
Q

length of time antobiotics continued for in PID?

A

14 days

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21
Q

antibiotics used in PID?

A

ceftriaxone
doxycycline
metronidazole

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22
Q

tment of trichomonas vaginalis?

A

metronidazole

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23
Q

tment for chlamydia trachomatis?

A

doxycycline or azithromycin

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24
Q

features of history of patient with PID?

A

lower abdom pain
abnormal vaginal bleeding/discharge
deep dyspareunia
history of STIs in past

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25
features of examination of patient with PID?
``` pyrexia >38 C lower abdom tenderness- bilateral adnexal tenderness cervical excitation discharge- vaginal or cervical, on speculum exam. ```
26
investigations in PID?
endocervical swab: gonorrhoea, chlamydia high vaginal swab: bacterial vaginosis, trichomonas vaginalis, candida- picked up, but not causative of PID +ve swabs support diagnosis but -ve don't exclude it
27
general medical management of PID?
analgesia- paracetemol- fever and pain | antibiotics- oral for mild to mod, IV if severe
28
when to admit PID patient to hospital?
surgical emergency cannot be excluded, causing acute abdomen clinically severe disease tubo-ovarian abscess PID in pregancy (v.rare as foetus in way for ascending infection) lack or response/intolerance to oral therapy
29
when might laparoscopy/laparotomy be considered for PID?
if no response to therapy clinically severe disease presence of a tubo-ovarian abscess an US-guided aspiration of pelvic fluid collections would be less invasive
30
possible SEs of metronidazole?
vomiting, this would be made worse if alcohol taken
31
what is a patient with PID at risk of in the future?
ectopic pregnancy as pelvic scars and adhesions infetility as tubal adhesions chronic pelvic pain- may need counselling Fitz Hugh Curtis syndrome- adhesions by liver
32
what is fitz hugh curtis syndrome?
perihepatitis presenting with R upper quadrant pain- acute in onset and sharp, due to transabdominal spread of infection from PID e.g. chlamydia trachomatis. The spread of disease from the pelvis to the liver may be due to circulation of fluid along the paracolic gutter- infracolic compartment of greater sac, it may be due to lymphatic drainage or it may be via the bloodstream.
33
How can risk of PID be reduced in patients who have had it previously?
use of barrier contraception
34
clinical presentation of primary genital herpes?
extensive, painful genital ulceration dysuria inguinal lyphadenopathy fever if recurrent genital herpes, may be asymptomatic to moderate
35
diagnosis of genital herpes?
smear (IF) and swab (viral culture) of vesical fluid and/or base of ulcer, and send for viral PCRs
36
How can risk of HSV transmission be reduced?
barrier contraception
37
tment of primary genital herpes and severe disease?
aciclovir- only activated within virally-infected cells as molecule produced by virus necessary for drug activation, so therefore minimses damage to cells not infected by the virus
38
what management can be given for frequent recurrences of genital herpes?
aciclovir prophylaxis
39
clinical presentation of genital warts?
cutaneous, mucosal and anogenital warts caused by HPV. Benign, painless, verrucous epithelial or mucosal outgrowths- penis, vulva, vagina, urethra, cervix, perianal skin
40
diagnosis of genital warts?
clinical, biopsy + genome analysis, hybrid capture- detect viral DNA
41
tment of genital warts?
``` frequent spontaneous resolution topical podophyllin cryotherapy intralesional interferon imiquimod- immune response modifier surgery ```
42
what infections might N.gonorrhoea cause in men?
epididymitis, prostatitis, proctitis- inflammation of lining of rectum, urethritis, pharyngitis
43
what infections might N.gonorrhoea cause in women?
PID, endocervicitis, urethritis may be asymptomatic with N.gonorrhoea
44
tment of N gonorrhoea infection?
ceftriaxone (IM)-cephalosporin also used to treat N.meningitidis ciprofloxacin (oral) used till very recently but has been superseded by resistance*
45
features of disseminated gonococcal infection?
bacteraemia, skin and joint lesions
46
diagnosis of gonorrhoea?
smear and culture
47
clinical presentation of chlamydial infections in females?
urethritis, cervicitis, salpingitis, perihepatitis
48
clinical presentation of chlamydial infections in males?
urethritis, epididymitis, prostatitis, proctitis
49
diagnosis of chlamydial infections?
endocervical and urethral swabs | 1st void urine
50
what is trichomonas vaginalis?
flagellated protozoan causes trichomonas vaginitis: thin, frothy, offensive discharge irritation, dysuria, vaginal inflammation
51
diagnosis of trichomonas vaginalis?
vaginal wet preparation +/- culture enhancement
52
causative agent of syphilis?
treponema pallidum
53
tment of syphilis?
penicillin and 'test of cure' follow-up
54
tment of bacterial vaginosis?
metronidazole
55
causes of bacterial vaginosis?
perturbed normal flora- gardnerella, anaerobes, mycoplasmas
56
RFs for vulvovaginal candidiasis?
antibiotics, oral contraceptives*, pregnancy, obesity, steroids, diabetes
57
tment of vulvovaginal candidiasis?
oral fluconazole | topical azoles or nystatin
58
specific at risk groups for STIs?
young people minority ethnic groups those affected by poverty and social exclusion low SE status poor education opps unemployed individuals born to teenage mothers- unprotected sex
59
stages of syphilis disease?
primary= indurated, painless ulcer secondary- 6 to 8wks later- fever, rash, lymphadenopathy, mucosal lesions tertiary- chronic granulomatous lesions quaternary- CVS and CNS pathology
60
diagnosis of syphilis?
dark field microscopy, serology
61
tment of trichomonas vaginalis infection?
metronidazole
62
bacteria, viruses, protozoa, and fungi can cause STIs? which arthropods can cause STIs?
scabies mite | pubic louse
63
why is bacterial vaginosis different from vaginitis?
bacterial vaginosis from perturbed normal flora, no inflammation
64
diagnosis of bacterial vaginosis?
clinical and laboratory clinical= vaginal pH>5, KOH whiff test laboratory= higher vaginal smear- clue cells- epithelial cells with gram -ve coccobacilli redcuced nos lactobacilli

ESA 4 (24 decks)

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