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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
Q

features of examination of patient with PID?

A 
pyrexia >38 C
lower abdom tenderness- bilateral
adnexal tenderness
cervical excitation
discharge- vaginal or cervical, on speculum exam.
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26
Q

investigations in PID?

A

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
Q

general medical management of PID?

A

analgesia- paracetemol- fever and pain

antibiotics- oral for mild to mod, IV if severe

28
Q

when to admit PID patient to hospital?

A

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
Q

when might laparoscopy/laparotomy be considered for PID?

A

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
Q

possible SEs of metronidazole?

A

vomiting, this would be made worse if alcohol taken

31
Q

what is a patient with PID at risk of in the future?

A

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
Q

what is fitz hugh curtis syndrome?

A

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
Q

How can risk of PID be reduced in patients who have had it previously?

A

use of barrier contraception

34
Q

clinical presentation of primary genital herpes?

A

extensive, painful genital ulceration
dysuria
inguinal lyphadenopathy
fever

if recurrent genital herpes, may be asymptomatic to moderate

35
Q

diagnosis of genital herpes?

A

smear (IF) and swab (viral culture) of vesical fluid and/or base of ulcer, and send for viral PCRs

36
Q

How can risk of HSV transmission be reduced?

A

barrier contraception

37
Q

tment of primary genital herpes and severe disease?

A

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
Q

what management can be given for frequent recurrences of genital herpes?

A

aciclovir prophylaxis

39
Q

clinical presentation of genital warts?

A

cutaneous, mucosal and anogenital warts caused by HPV. Benign, painless, verrucous epithelial or mucosal outgrowths- penis, vulva, vagina, urethra, cervix, perianal skin

40
Q

diagnosis of genital warts?

A

clinical, biopsy + genome analysis, hybrid capture- detect viral DNA

41
Q

tment of genital warts?

A 
frequent spontaneous resolution
topical podophyllin
cryotherapy
intralesional interferon
imiquimod- immune response modifier
surgery
42
Q

what infections might N.gonorrhoea cause in men?

A

epididymitis, prostatitis, proctitis- inflammation of lining of rectum, urethritis, pharyngitis

43
Q

what infections might N.gonorrhoea cause in women?

A

PID, endocervicitis, urethritis

may be asymptomatic with N.gonorrhoea

44
Q

tment of N gonorrhoea infection?

A

ceftriaxone (IM)-cephalosporin also used to treat N.meningitidis
ciprofloxacin (oral) used till very recently but has been superseded by resistance*

45
Q

features of disseminated gonococcal infection?

A

bacteraemia, skin and joint lesions

46
Q

diagnosis of gonorrhoea?

A

smear and culture

47
Q

clinical presentation of chlamydial infections in females?

A

urethritis, cervicitis, salpingitis, perihepatitis

48
Q

clinical presentation of chlamydial infections in males?

A

urethritis, epididymitis, prostatitis, proctitis

49
Q

diagnosis of chlamydial infections?

A

endocervical and urethral swabs

1st void urine

50
Q

what is trichomonas vaginalis?

A

flagellated protozoan
causes trichomonas vaginitis: thin, frothy, offensive discharge
irritation, dysuria, vaginal inflammation

51
Q

diagnosis of trichomonas vaginalis?

A

vaginal wet preparation +/- culture enhancement

52
Q

causative agent of syphilis?

A

treponema pallidum

53
Q

tment of syphilis?

A

penicillin and ‘test of cure’ follow-up

54
Q

tment of bacterial vaginosis?

A

metronidazole

55
Q

causes of bacterial vaginosis?

A

perturbed normal flora- gardnerella, anaerobes, mycoplasmas

56
Q

RFs for vulvovaginal candidiasis?

A

antibiotics, oral contraceptives*, pregnancy, obesity, steroids, diabetes

57
Q

tment of vulvovaginal candidiasis?

A

oral fluconazole

topical azoles or nystatin

58
Q

specific at risk groups for STIs?

A

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
Q

stages of syphilis disease?

A

primary= indurated, painless ulcer
secondary- 6 to 8wks later- fever, rash, lymphadenopathy, mucosal lesions
tertiary- chronic granulomatous lesions
quaternary- CVS and CNS pathology

60
Q

diagnosis of syphilis?

A

dark field microscopy, serology

61
Q

tment of trichomonas vaginalis infection?

A

metronidazole

62
Q

bacteria, viruses, protozoa, and fungi can cause STIs? which arthropods can cause STIs?

A

scabies mite

pubic louse

63
Q

why is bacterial vaginosis different from vaginitis?

A

bacterial vaginosis from perturbed normal flora, no inflammation

64
Q

diagnosis of bacterial vaginosis?

A

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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