Reproduction/Sexual Health Flashcards
Gold standard investigation for endometriosis
Diagnostic laparoscopy
Treatment to prevent miscarriage in pt with anti-phospholipid syndrome
Low-dose aspirin and low-molecular-weight heparin (LMWH)
19yr old P0+0
Sudden onset RIF pain
Feeling faint
HCG positive
Hypotension
Tachycardia
Apyrexial
Ectopic pregnancy
- inv bloods/G&S, US, FAST trans vaginal US
- manage medical/conservative/surgical/vacuum
19yr old P0+0
Sudden onset RIF pain
Nausea and vomiting
HCG negative
Tachycardia
Normotensive
Apyrexial
Ovarian torsion
- inv bloods/CRP/G&S, palpable mass on VE, US
- manage resus, laparoscopy, detorsion, cystectomy, oopherctomy
19yr old P0+0
Gradual onset RIF pain
Anorexia
Nausea and vomiting
Diarrhoea
HCG negative
Normal HR and BP
Rebound/guarding
Rovsing’s positive
Raised WCC/CRP
Normal repro organs
Appendicitis
- inv CT
- manage appendectomy
19yr old P0+0
Sudden onset RIF pain
Occurred after sexual intercourse
HCG negative
Tachycardic
Hypotensive
Aprexial
Cyst rupture
- inv bloods/CRP/G&S, peritonism, US
- manage conservative/resus, laparoscopy, lavage, oopherectomy
19yr old P0+0
Gradual onset lower abdominal pain
Anorexia
Intermenstrual and post coital bleeding
Discharge
HCG negative
Normal HR & BP
Pyrexial
PID
- inv FBC/CRP/LFT, cervical motion tenderness, genital swabs
- manage 14 days metronidazole and doxycycline, STI counselling
Primary investigation for premature menopause (under 45)
Serum FSH
Management of HPV positive cytology on smear but no dysplastic changes
Repeat smear in 12 months, safety net in meantime
Which contraception would you advise in a young patient wanting period control and has migraine with aura?
Progesterone only method
Pt in 3rd trimester presents with severe abdominal pain, vomiting with a history of fibroids
Red dgeneration of fibroids
- the effect of oestrogen on fibroids late in pregnancy causes them to grow and blood vessels expand
- conservative management, reassure pt
Management of BV
Oral metronidazole
55 year old having sex with multiple partners, wants to have coil replaced, what do you recommend?
Advise barrier method of contraception
- hormonal control puts her at higher risk of cancer given her age
Management of gonorrhoea
IM ceftriaxone
16 year old, not started periods yet, normal ovaries and uterus on USS, what’s the likely diagnosis?
Hypogonadotrophic hypogonadism
Management of PID
Ceftriaxone IM + doxycycline (+ metronidazole)
Ofloxacin + metronidazole
Essentially just make sure what you’re giving covers the organisms causing the PID
Bright red ring surrounding cervical os, assoc with post-coital bleeding
Cervical ectropion
Which method of delivery poses the lowest infection risk for an HIV+ patient with a viral load >50?
C-section
25 year old presents with heavy bleeding, pelvic pressure and palpable mobile mass in lower abdomen
Fibroids
Whirpool sign on USS
Ovarian torsion
Types of HPV most assoc with cervical cancer
16 and 18
Investigation to confirm diagnosis of PID
Endocevrical swab
Medical management of PCOS
Clomifene citrate
When should serum progesterone test be carried out in menstrual cycle to assess fertility?
7 days before end of cycle
e.g. day 21 in a 28 day cycle
e.g. days 25 in a 32 day cycle
How often should HIV+ patients be getting cervical smear tests after diagnosis?
Annually
- due to incr risk for HPV and thus cervical cancer
Contraindications to HRT
Undiagnosed vaginal bleeding
Pregnancy
Breastfeeding
Oestrogen receptor-positive breast cancer
Acute liver disease
Uncontrolled hypertension
History of breast cancer or venous thromboembolism (VTE)
Recent stroke, myocardial infarction or angina
What substance is used during smear tests to visualise abnormal cells on the surface of the cervix?
Acetic acid
- appears bright white next to pink and healthy cervical tissue
For how long should patients beginning menopause after 50 continue to use contraception after their last period?
1 year after lastperiod
Pres of cystocele
Herniation of bladder into vagina
- stress incontinence, natural birth, anterior wall prolapse
Diagnosis of premature ovarian insuffieciency
- under the age of 40
- symptoms of menopause (eg. period cessation)
- two FSH measurements of >25 IU/l
What type of HRT in menopausal pts with continuing periods?
Monthly cyclical HRT
Primary amenorrhoea, no breast development, webbed neck, wide chest, recurrent ear infections as a child?
Turner syndrome (hypergonadotrophic hypogonadism)
Heavy menstrual bleeding assoc with fatigue, weight gain, constipation and cold intolerance?
Hypothyroidism can be a really common cause of this!!!!!
Mainstay treatment for ovarian cancer
Chemo (platinum) and surgery (bilat salpingooopherectomy)
Why does chemo not work in slow growing cancers e.g. low grade ovarian tumours?
Chemo only works on hyperactive and fast replicating cells
Tumour markers for young pt with ovarian cancer
AFP, LDH, HCG, Ca125
Endo thickness on TVUS at which to offer endo biopsy
4mm
When can fibroids cause bleeding in post-menopausal bleeding?
If pt on HRT, oestrogen stimulates the fibroids
Why does ovarian cancer cause build up of ascites?
Intense mesothelial irritation
Low protein causes fluid toleak out into abdo space
Meek syndrome pres
R sided pleural effusion, benign ovarian mass, ascites
- transudate tends to accumulate in R side
If individual is negative high risk HPV on routine smear, when is their next smear?
5 years
When is test of cure done after treatment of high grade cervical neoplasia?
Smear at 6 months
Gardasil 9 vaccine protects against which types of HPV?
16
18
31
33
Hormone findings in PCOS
Raised testosterone, low sex hormone binding globulin (SHBG), raised luteinising hormone (LH) and normal follicle-stimulating hormone (FSH)
Menorrhagia, a bulky uterus on examination and a history of infertility are highly suggestive of?
Uterine fibroids
First line investigation for post-coital bleeding
Speculum exam and pelvic exam before anything else
Most common type of vulval cancer
Squamous cell carcinoma
Why is mefanamic acid used to manage dysmennhoroea and menorrhagia?
NSAID with anti-inflamatory function to reduce bleeding
It works by inhibiting prostaglandin synthesis and is better tolerated than tranexamic acid
Ratio of LH to FSH in PCOS
High LH:FSH
Hormone levels in premature ovarian failure
Raised LH, raised FSH, low oestradiol levels
Pres of PID
Dysuria
Menorrhagia
Purulent vaginal discharge
Objective markers of infection and inflammation.
Can testosterone replacement cure male infertility?
No, because it does not act on sperm producing cells in the testes. Gonadotrophin therapy is required for this to happen.
Why is Mirena coil better option than COCP in patient with heavy menstrual bleeding which is not controlled by tranexamic acid?
mirena is local
fewer side effects
don’t have to remember to take pill
Diagnosis of premature ovarian insufficiency
Elevated serum follicle-stimulating hormone (FSH) levels (>30 IU/l) on two samples taken 4–6 weeks apart
- woman under 40
- absence of periods for 12 months
Medical management of endo in a patient with Hx of DVT who smokes 20 cigarettes a day
POP
When are corpus luteum cysts seen?
In early pregnancy when the corpus luteum fails to break down
Why might a post-menopausal patient wit systemic symptoms not require progesterone RT?
Pt will only need progesterone if they have a uterus
- there’s no risk of endo cancer if pt does not have a uterus to be affected by unopposed oestrogen
Right upper quadrant pain, associated with shoulder tip pain and Hx of untreated chlamydia?
Fitz-Hugh-Curtis syndrome
Mech of action of misoprostol
synthetic prostaglandin that encourages the expulsion of the products of conception.
Period of greatest teratogenic risk from drug exposure
4-11 weeks
Management of bleeding in anaemic women before surgeyr
Gosrelin
- GnRH analogue that can be given prior to surgery to manage bleeding in anaemic women due to fibroids prior to surgery
Why do you get bloating in ovarian cancer?
cancer cells spread to peritoneum -> block lymphatic drainage -> ascites -> bloating
big ovaries -> mass effect -> less space in tummy for food
First line management uterine prolapse
Vaginal pessary
- rubber/plastic capsules that sit in vagina and essentially hold its shape
Mangement of pt who has missed 2 pills in a row in one pack and only remembered to take the 2nd one
Omit the 1st forgotten pill
Finish pack
Start new pack immediately (no pill-free break)
Decr visual acuity in HIV+ pt, fundoscopy shows spots within the retina, along with flame shaped haemorrhages.
CMV retinitis
- looks like pizza pie retina
- manage Intraocular Ganciclovir and PO Valganciclovir
Amsel criteria for BV
elevated vaginal pH, homogeneous discharge, positive whiff test, and presence of clue cells on wet mount.
Mech of action of doxycycline
Protein synthesis inhibition by blocking the 30S ribosomal subunit
Chancroid vs syphilis vs LV
Chancroid - Painful ulcer and tender lymphadenopathy
Syphilis - Painless ulcer and non-tender lymphadenopathy
Lymphogranuloma venereum - Painless ulcer and tender lymphadenopathy
Mangement of chancroid
Prescribe Ciprofloxacin and Ceftriaxone
Why are first babies unaffected by Rh status but second babies are?
IgM
- big antibody, can’t cross plaenta
IgG
- second babies, much smaller Ab
If Rh-ve mother is already sensitised to Rh+ve antibodies, would you give anti-D?
She’s already sensitised so anti-D won’t do anything to protect against haemolytic disease
How to manage Rh disease?
US to assess for signs of anaemia and blood flow to brain via MCA doppler
- baby will try to speed up blood flow to brain to compensate
- if doppler is elevated = baby is anaemic
Transfuse baby at foetal medicine unit in Glasgow
Normal foetal HR
110-160bpm
Management of pt presenting with triad of 5% prepregnancy weight loss, dehydration and electrolyte imbalance
Oral promethazine/cyclizine
- pt has hyperemesis gravidarum
Folic acid amount for pregnant mothers with BMI 30 and above
5mg
Fetal symptoms of maternal rubella infection
Sensorineural deafness
Congenital cataracts
‘Blueberry muffin’ rash
Salt-and-pepper chorioretinitis
Management of gestational diabetes
<7mmoll Metfomin 00mg OD if lifestyle/diet measures don’t work
>7mmoll Isophane insulin injection OD in the morning
Why is sertraline used in PPD rather than fluoxetine in a breastfeeding part?
Sertraline has a low milk-to-plasma ratio.
Fluoxetine should be avoided due to its long half-life.
When is anti D given in first pregnancy if no exposing event?
a one-dose injection between 28 and 30 weeks of pregnancy
OR two doses of injections at 28 weeks and 34 weeks of pregnancy.
Management of itch in obstetric cholestasis
Ursodeoxycholic acid
When is category 1 C section indicated?
Immediate threat to the life of mother or baby and delivery should expedite immediately within 30 minutes
- e.g. cord prolapse
Testing for gestational diabetes in someone with a high risk factor
OGT between 24-28 weeks
When is first anti-D dose given?
28 weeks
- or I think any blood exposing event
Management asymptomatic post-natal anaemia
Oral ferrous fumarate 200mg OD
Define vasa praevia
Foetal blood vessels run through the free placental membranes, unprotected by the umbilical cord
The foetal blood vessels run across internal os
Presents dark red bleeding
Management of premenopausal women with oestrogen-receptor-positive breast cancer.
Tamoxifen
Strawberry cervix, foul smelling discharge and lower abdo tenderness?
Trichomonas
Fever, sore throat, mouth ulcers and upon inspection it is noted there is a widespread maculopapular rash on chest?
HIV primary infection
Woody uterus
Placental abruption
Positioning of pt when cord prolapse occurs
Ask the patient to go on all fours, on knees and elbows
Presentation of Potter syndrome
Poor urine outflow and oligohydramnios causing pulmonary hypoplasia due to bilateral renal agenesis
Pres of acute fatty liver of pregnancy
Abdominal pain, nausea, vomiting, headache, jaundice, hypoglycaemia
- in severe cases, pre-eclampsia
Increased ALT above 500
Management malignant Phyllodes tumour
Clear margin excision
Lambert Eaton vs Myasthenia Gravis antibiodies
LE - Anti-voltage-gated Ca channel
MG - Anti-ACh
4 keymeasures to manage PPH (other than ABCDE etc)
Rub fundus
Catheterise
Oxytocin or other meds
Balloon (or suture, ligation, hysterectomy)
Why do you give magnesium sulfate in eclamptic seizures?
Terminates seizure, prevents further seizures
- protects parent and foetus
Limb hypoplasia, skin scarring and eye defets are all birth defects due to which virus…
Varicella zoster intrapartum
- Manage by testing for antibodies, if absent then dose oral aciclovir 24h after rash starts
Woody uterus
Placental abruption
How can you remember placental adhesion conditions?
Accreta - AT muscle
Increta - IN muscle
Percreta - PAST muscle
1st preg, rhesus neg and no sensitising events?
Anti-D at 28 weeks
+ Further dose if any sensitising events
G6 P3+2
Think of it as events
6 gravid events (pregnancies)
3 parous events (births incl stillbirth, twins = 1)
+ terminations/miscarriages (after 24w)
Why does twin pregnancy put you at high risk of PET?
Larger/multiple placenta = more problematic spiral arterioles
What one manoeuvre should you avoid in shoulder dystocia?
Fundal pressure
- incr risk of uterine rupture
Smooth firm breast lump, recently stopped breast feeding
Galactocele
- build up of milk causes cystic lesion
Most common med given before C section
Omeprazole
- prevents reflux by reducing gastric vol and acid
- decr risk of aspiration and subsequent pneumonitis
Large, sick, bleeding pregnancy
Molar pregnancy
- large for dates
- lots of nausea/vomiting
- intrapartum bleeding
Broad ligament contains
Ovaries and uterine tubes
- connects then to pelvic wall
Painful lumpy boobs before period
Fibroadenosis
Highest risk HPv for cervical cancer
16+18+33
Mechanism of action of combined contraceptives
Inhibits ovulation (oestrogen) and thickens cervical mucus (progesterone)
Management of meningitis in pregnancy
IV ceftriaxone and IV amoxicillin
- IV chloramphenicol and IV co-trimoxazole if severe pen allergy
Every pt who has a wide local excision should also have…
Adjuvant raditherapy
- proven to reduce recurrence
MoA of tamoxifen
Oestrogen receptor antagonist
Smoking is a keeeeeyyyyyyy riak factor for which breast disease?
Periductal mastitis
- reduces vitamin A to cause chronic ductal inflammation
- pres with inverted nipple, bloody discharge, sinus draining pus
MoA of letrozole
aromatase inhibitor
- medication of choice for postmenopausal women with oestrogen-receptor-positive breast cancers
What does triple negative mean?
Breast cancer negative for oestrogen receptor, progesterone receptor, and HER2 expression
Limited movement of arm and tightening of skin at axilla 4 weeks post-breast surgery
Axillary web syndrome
formation of fibrous cords that extend from the axilla to the ipsilateral hand.
Drugs lowering seizure threshold
“I am Tramadol’s friend, keeping life less anxious”
I for imipenem
AM for abx:penicillins, cephalosporins, metronidazole, isoniazid
Tramadols for tramadol
Friend for fentanyl
Keeping for ketamine
Life for lidocaine
Less for lithium
Anxious for antihistamines
Breast cancer difficult to see on mammogram
Invasive lobular carcinoma
- most have MRI to ID and stage
When should ECV be offered for breech baby?
36w for primigravid
37w for multigravid
Membrane or induction of labour for 41weeker as first line?
Membrane sweep
- if doesn’t work, proceed to IoL
Fundal pressure is contraindicated in shoulder dystocia, why???
Risk of brachial plexus injury
Key risk for thomboembolism in pregnancy
Multiple pregnancy
WHat is reassuring variability on CTG?
5-25bpm
What sort of variability would be non-reassuring?
Less than 5 bpm for between 30-50 minutes
More than 25 bpm for 15-25 minutes
What is abnormal variability on CTG?
Less than 5 bpm for more than 50 minutes (sawtooth)
More than 25 bpm for more than 25 minutes
Sinusoidal (like a sine wave)
What is acceleration?
abrupt increase in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds
- reassurance, but absence shouldn’t be too worrying
Main cause of variable deceleration
(apid fall in baseline fetal heart rate with a variable recovery phase)
Umbilical cord compression
When do you see late decelerations?
Start at peak of the uterine contraction and recover after the contraction ends.
- maternal hypoT, PET, uterine hyperstimulation
WHen do you worry about prolonged decelerations?
If it lasts between 2-3 minutes it is classed as non-reassuring.
If it lasts longer than 3 minutes it is immediately classed as abnormal.
Most worrying CTG pattern
Sinusoidal
- v rare but v bad
- Severe fetal hypoxia
- Severe fetal anaemia
- Fetal/maternal haemorrhage
Gush of fluid and drop in foetal heart rate in a previously normal pregnancy in G5 P4
Umbilical cord prolapse
- more common in high parity, polyhydramnios, artificial ROM, malpres
WHat is the one medical CI to COCP you keep forgetting?
Postnatal period
Management of ectopic >35mm or bHBG >1500
Surgical
Trimethoprim safe in pregnancy?
Third trimester yes
Bishop score
posterior cervical position
firm consistency
40-50% effacement
2cm dilation
foetal station at -2
Bishop score >6
Amniotomy and IV oxytocin
(cerv ripening balloon if hyperstim risk or prev CS)
Bishop score <6
Vaginal prostaglandin
Oral misoprostal
How to remember the contraindications to COCP on UKMEC?
Abnormal clotting 3
Hypertension 4 (controlled 3)
Nocked up
Obesity >35BMI 4
Breastfeeding/PP <4
Aura migriane 4
Breast cancer 4
Immobility (prolonged 4, reduced 3)
hEpatoma/reduced clotting 3
Smoking >15 + >35
Fasting glucose >7 in pregnancy
Insulin
(metformin or diet advice if <7)
Urge vs stress incontinence mangement
Stress = SNRI (Duloxetine)
URge = URO = Oxybutynin
Methotrexate and conception
Must stop 6 months before trying to conceive
Which hepatitis is screened for in pregnancy?
Hep B
Layers cut/pulledapart in C section after skin and fat
Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus
43%
Mnemonic for shoulder dystocia management
H- call for help
E- evaluate for episiotomy
L- leg to McRoberts
P- supraPubic Pressure
E- enter: rotational manouevres
R- remove the posterior arm
R- roll pt to hands and knees
Hormone levels in PCOS
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
CI in ullipristal/ellaONE
Severe asthma
When should C section happen with twins?
36w if monochorionic
37w if dichorionic
Triple test results in Down syndrome
Everything is DOWN, except what is HI (HCG, Inhibin A)
Vasa praevia triad
Painless vaginal bleeding, rupture of membranes and fetal bradycardia (fetal heart rate <100bpm)
Which layer of uterus regenerates tissue lost in menstruation?
Stratum basalis
- makes it Big again
When do the ovaries contain the most germ cells?
7 months gestatin
Two uteri would result from which embryological problem
An incomplete fusion of the paramesonephric duct
What structure develops to form the vas deferens?
Mesonephric duct
Which structre develops to form the superior portion of the vagina?
Paramesonephric duct
Who regulates assisted conception and embryo research?
HFEA
- research up to 14 days
Azoospermia and vasectomy - what method of assisted conception?
Surgical sperm aspiration and ICSI
Most common cause of obstructive azoospermia
CF
How many UK couples get infertility assessment?
1 in 6
First line after unexplained infertility
IVF
How long do pubic lice live?
Male 22 days
What % of infertility treatment is due to male factor infertility?
30%
Where does spermatogenesis occur?
Seminiferous tubules
Which structure loosens in late pregnancy and can cause pelvic pain?
Pelvic inlet
Foetal vertex is bordered by….
Anterior and posterior fontanelles and the parietal eminences
Diagnosis of BV
Clue cells on VV swab
What percent of abnormal uterine bleeding is caused by dysfunctional uterine bleeding?
50%
What info is required when requesting endo biopsy
Date of last menstrual period
Pattern of bleeding
Hormonal therapy
Age
Legal limit for social TOP
23+6 weeks
Yellowish/green frothy discharge along with itching and soreness
Trichomonas
- pH >4.5
- manage with metro 5-7 days 500mg
- or metro 2g one off
Most common cause of CMV retinitis in people with advanced immunosuppression
Reactivated infection
COCP protects against whch type of cancer
Ovarian and endometria
Factors affecting regret for sterilisation
Young age <30 yr old
Few or no children
Not in a mutually faithful relationship or not in a relationship
Coercion by partner or medical personnel
Done at time of ToP or childbirth
WHat type of endo is rare?
Ovarian endo
Which muscle cvers the majority of the pelvic side wall?
Obturator internus
Does FRV increase of decrease during pregnancy?
Decrease
How does CV function change in pregnancy?
Incr contractability
RFs for pelvic girdle pain
Increased BMI before pregnancy
History of low back and pelvic pain or pelvic trauma
Hard physical job / poor work ergonomics
PGP in a previous pregnancy
Boundaries of pelvic outlet
anteriorly by the pubic arch
laterally by the ischial tuberosities
posteriorly by the coccyx.
Mx suspected PE in pregnancy
Chest examination, ECG, Chest Xray, admit to hospital, treatment dose with dalateparin and arrange VQ test
Does maternal anaemia affect growth of foetus?
No
Does IVF affect growth of foetus?
Yes
- recognised cause of IUGR
Is big previous baby an indicating for GD screening?
Yessssss
What type of anaesthesia can you not get with forceps delivery?
General
Pain from the body of the uterus is carried by
Visceral afferent fibres to T11-L2 spinal cord levels
Painless, usually recurrent bleeds in third trimester
Placenta praevia
VSD and dysplastic kidneys assoc with which substance in pregnancy
Alcohol
Classic signs indicating placental separation
Uterus contracts, hardens and rises
Increasing length of umbilical cord is visible at the introitus
Gush of blood appears
Mother has feeling of fullness in vagina
Mania-like behaviour 1 week post partum?
Puerperal psychosis
3 types of 3rd degree perineal tear
3a <50% of external anal sphincter, 3b > 50% of external anal sphincter, 3c internal anal sphinter
Function of ductus arteriosus
To oxygenate the fetal venous return using the right ventricle
3 key obstetric emergencies that would require a Datix
Maternal PPH >500ml
3rd or 4th degree perineal tear
Shoulder dystocia
Which hormones stimulate the breasts to grow?
At puberty -oestrogen
After, extra growth -progesterone
Which hormones stimulate lactation?
Milk production - prolactin
Duct contraction - oxytocin
Most common breast cancer
Invasive ductal carcinoma
How common is UK breast cancer?
1 in 8
Extensive micocalcification confined to one quadrant on mammogram
DCIS
Young pt with painless, firm, discrete, mobile mass, which has a solid appearance on ultrasound scan
Sclerosing adenosis
Side effects of adjuvant radiotherapy to breast
Skin changes
Fatigue
Brachial plexopathy
Pulmonary fibrosis
Most common cause of puerperal pyrexia
Endometritis
LFTs in acute fatty liver of pregnancy
Hepatic pattern of derangement
AST/ALT > ALP/GGT
Anastrozole =
After menopause
Management of chickenpox exposure and infection in pregnancy
Exposure
-<20 wk non-immune - VZIg within 10 days
->20 wk non-immune - VZIg / acyclovir after 7-14 days
Chickenpox developed in pregnancy
< 20 wk - consider acyclovir with caution
>20 wk - acyclovir within 24hr of rash
Nuchal translucency, PAPPA and HCG decr
Inhibin A incr
Patau (13) or Edward’s (18)
When should you worry and refer on about lack of foetal movement?
24 weeks
- when foetus becomes viable
- 2, 4, kick the door
Management DVT in pregnancy
LMWH and monitor with anti-Xa activity
If pt has glucose >7 and has trialled max dose metformin and diet changes
Add on insulin
- don’t stop the metformin
FL management of cord prolapse while awaiting C section
Push presenting part of foetus back up
Catheterise and fill bladder with 500-700ml saline
HIV positive man comes to the emergency department with headache and fever for the last two days - CT shows ring enhancng lesion
Toxoplasmosis
- Administer sulfadiazine and pyramethamine
Single non-tender penile ulcer with painful inguinal lymphadenopathy, associated fever and muscle pain
LGV
Deep ulcer with a soft, irregular border and a friable base
Chancroid
Most effective culture method for HSV
NAAT
Management of trichomoniasis
Metronidazole 2g PO STAT
- treat both partners
Thrush as an AIDS defining illness
Oesophgeal candidiasis
Most common cause of BV
Gardnerella vaginalis
Unwell, with a higher fever, high heart rate, and a widespread rash after receiving benzylpenicillin for syphilis
Jarisch-Herxheimer reaction
- reassurance and paracetamol
Findings on micro for cryptococcal meningitis
Encapsulated yeast organisms on India ink stain
WHen should new breast lump be refd to breast clinic?
Under 30 - routine referrral
30 and over - urgent referral
Paget’s disease is assoc with which type of breast cancer
DCIS
When is US used in breast lump?
<40 and asymptomatic
<35 and symptomatic
Dense breast tissue
HER2-receptor-positive breast cancer endocrine management
When is fluclox given in mastitis?
If pt is:
- systemically unwell
- a positive culture is seen
- a nipple fissure is present
- if symptoms do not improve after 12–24 hours of milk expression.
Rapidly growing fibroadenoma
Phyllodes tumour
- commonly affect people in 40s and 50s
3 Fs of Phyllodes
Forties
Fast growing
Fibroadenoma
Arthralgia, menopausal symptoms, hypercholesterolemia, osteoporosis, and rarely Henoch–Schönlein purpura
- which breast cancer treatment is responsible?
Anastrozole
- aromatase enzyme inhibitor
Management of cervical cancer to maintain fertility
IA1 to maintain fertility- core biopsy and follow up
IA2 to maintain fertility - LLETZ
Bishop score >10
Likely to spontaneously labour
Bishop score <5
Likely to need induced
Antiemetic causing tremor and hypertonia
Metoclopramide
Most common identifiable cause of post coital bleeding
Cervical ectropion
Salpingectomy vs salpingotomy
ectomy - removal of tube, if no contralateral tube problems then fertility is still preserved
otomy - removal of tube contents, might still need treatment withe methotrexate etc
How can you reduce uterine contraction in
Tocolytics e.g. terbutaline or nifedipine
EPDS interpretation
<13 and no impact on ADL = CBT
>13 probs impacting on ADL = SSRI and CBT
Any risk/suicidal = inpatient ref
Psammoma bodies
Serous cystadenocarcinoma
Urethritis with >5 polymorphs per field, and no gm-neg diplococci - how do you treat?
Treat as chlamydia with doxycycline
Management of primary CNS lymphoma
Commence cART and whole brain irradiation
What pregnancy condition is a CI to the COCP?
Cholestatic jaundice
Cause of Kaposi’s
Human herpesvirus 8
Mx of genital warts
Inquimod
- cryotherapy if pregnancy
Itchy rash on palms and soles, maybe had a genital lesion a few weeks ago that’s now healed
Syphilis (trepenoma)
