Reproductive conditions

Question 1

What is the causative agent of gonorrhoea? How is it classified?

Answer 1

Neisseria gonorrhoea, gram -ve bacilli

Question 2

What percentage of males and females with gonorrhoea are symptomatic?

Answer 2

90% males, 50% females

Question 3

What are the male symptoms of gonorrhoea?

Answer 3

urethral discharge (mucupurulent - remember Ugandan man?)

Question 4

What are the female symptom of gonorrhoea?

Answer 4

change in vaginal discharge, mucupurlent

Question 5

What are the investigations for gonorrhoea?

Answer 5

NAAT, of urine for men endocervical / VV swab for women

Question 6

What is the management of gonorrhoea?

Answer 6

ceftriaxone 500mg IM stat, azithromycin 1g PO stat

Question 7

What must be done after treatment gonorrhoea?

Answer 7

test of cure

Question 8

What is the classification of organism causing chlamydia?

Answer 8

Gram -ve bacilli

Question 9

What percentage of makes an females are symptomatic for chlamydia?

Answer 9

Men - 50%, women 30%

Question 10

What are the male and female features of chlamydia?

Answer 10

Male - urthethritis, urethral discharge, urinary symptoms, epydidimo orchitis

female - discharge, dysuria, abdo pain, fever FRIABLE COBBLESTONE CERVIX, mucupurlent endocervical discharge

Question 11

Investigations for chlamydia

Answer 11

NAAT - VV for women, first catch urine for men

Question 12

Management chlamydia

Answer 12

Doxycycline 100mg BD 7/7, (not in pregnancy) or azithromycin 1g stat

Question 13

What are the complications of chlamyda in pregnancy?

Answer 13

premature, preterm

Question 14

Classify the causative agent of syphillis

Answer 14

treponemes (think of Swiss Dan and his treponemes)

Question 15

What are the symptoms of primary syphillis

Answer 15

painless ulcer, lymphadenopathy

Question 16

What are the symptoms of secondary syphillis

Answer 16

night time headaches, malaise, fever, aches, rash

Question 17

What are the symptoms of tertiary syphillis?

Answer 17

neurological - dementia, menigovascular involvement,

CVD - aortitis, aortic regurg

Gummata

Question 18

what are the investigations for syphillis?

Answer 18

VDRL, FTA ABS, EIA (treponemal enzyme immunoassay) IgM

Question 19

What is the management of syphillis?

Answer 19

1st line - benzylpenicillin IM stat, 2d line - azithromycin 2g PO STAT

Question 20

What is the epidemiology of breastfibroadenoma? What are the RF?

Answer 20

Common in young women, driven by oestrogen, so RF = cocp, hrt

Question 21

What is a breast lobule, what is a breast duct?

Answer 21

Lobule - end part (like alveoli) duct - tubey part (like bronchioles)

epithelium lined

Question 22

What is the definition of a fibroadenoma?

Answer 22

benign mass in lobules composed of fibrous and epithelial tissues, grow to 2-3cm

Question 23

Features breast fibroadenoma

Answer 23

Firm, non tender, highly mobile

Question 24

What investigations are needed for fibroadenoma?

Answer 24

hx/ex, USS, refer to breast doc,

Question 25

Management needed for fibroadenoma

Answer 25

Careful watching, relief of syx - bras, analgesia

Question 26

What are the types of breast cancer? Which are most common?

Answer 26

ductal, lobular, invasive, in situ most arise from epithelium of lobules / ducts

Question 27

what is Paget's disease of breast?

Answer 27

Ca that infiltrates nipple / epithelium

Question 28

What is inflammatory breast ca?

Answer 28

rapidly growing, painful mass,

Question 29

Risk factors for breast ca?

Answer 29

*driven by oestrogen* so COCP, HRT, nullips, early period, late menopause

Question 30

Clinical features breast Ca

Answer 30

painless lump, nipple inversion, nipple discharge

Question 31

most common sites of mets for breast ca

Answer 31

brain, bone, lung, liver BBLL

Question 32

What is the triple assessment? what other inv are needed for breast ca?

Answer 32

hx/ex mammography +US >35, <35 - US biopsy / fine needle incision also needed - sentinal node biopsy, CT for mets

Question 33

2 week wait rules for breast cancer

Answer 33

>30 and unexplained breast lump >50 with discharge, retraction

Question 34

Management of breast ca

Answer 34

wide local excision - always need radiotherapy mastectomy endocrine if er +ve or pr -ve radiotherapy chemotherapy (if young)

Question 35

define mastitis

Answer 35

inflammation of breast, non-infectious / infectious in origin

Question 36

define breast abscess

Answer 36

localised collection of pus

Question 37

causative organisms in peurperal breast abscess, or non peurperal breast abscess

Answer 37

peurperal - staph aureus, strep non peuperal - mixed flora

Question 38

Features of breast abscess

Answer 38

most frequently - areolar / periareolar oedema, tenderness, erythema

Question 39

investigations breast abscess

Answer 39

USS, Fine needle asp / drainage

Question 40

management breast abscess

Answer 40

>3cm - refer to surgeons <3cm - fine needle drainage abx- naficillin / vanco / clinda