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Yr 5 - Obs & Gynae > Revision 2 > Flashcards

Revision 2 Flashcards

1
Q

Can COCP be used in breastfeeding?

A

NO

UKMEC4 if breastfeeding and <6 weeks portpartum

UKMEC2 if breastfeeding and >6 weeks postpartum

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2
Q

When can a copper coil or intrauterine system (e.g. Mirena) be inserted after birth?

A

Either within 48 hours after birth OR 4 weeks after birth (not in between - UKMEC 3)

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3
Q

What type of condoms can be used in latex allergy?

A

Polyurethane condoms

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4
Q

How long must diaphragms/cervical caps be in place following intercourse?

A

6 hours

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5
Q

COCPs containing what are considered first-line for premenstrual syndrome?

Why?

A

Drospirenone –> antimineralocorticoid effects help with bloating, water retention, mood changes etc

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6
Q

COCPs containing what are considered in the treatment of acne and hirsutism?

A

Cyproterone acetate (i.e. co-cyprindiol) –> anti-androgen effects

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7
Q

What is potential risk in COCPs with co-cyprindiol?

A

Greater risk of VTE - only use for 3 months

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8
Q

Risk of which cancers are REDUCED with the COCP?

A

Ovarian, endometrial & colon

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9
Q

Risk of which cancers are INCREASED with the COCP?

A

Breast and cervical

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10
Q

What UKMEC is a BMI > 35 for the COCP?

A

UKMEC 3

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11
Q

Starting the COCP on what day of the cycle offers protection straight away?

A

Day 1-5

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12
Q

COCP and major operations?

A

Should be stopped 4 weeks before

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13
Q

What is the only UKMEC 4 criteria for POP?

A

Active breast cancer

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14
Q

What must be excluded where irregular bleeding is persistent >3 months after starting the POP?

A

STIs, pregnancy or cancer.

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15
Q

How often is the contraceptive injection given?

A

Every 12w (3m)

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16
Q

Why is the progesterone only injection less suitable for women wishing to great pregnant in the near term?

A

Can take up to 12m for fertility to return

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17
Q

What is a potential long term complication of DMPA?

A

Osteoporosis

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18
Q

What is the main mechanism of action of the progesterone injection?

A

Inhibits ovulation

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19
Q

What 2 side effects are unique to the progesterone only injection?

A

1) weight gain
2) osteoporosis

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20
Q

Between what ages is Nexpanon (implant) licensed for use?

A

18 and 40 y/o

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21
Q

What is the most effective form of contraception available?

A

Implant

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22
Q

What guidelines are used for providing contraception to patients under 16 years without having parental input and consent?

A

Fraser guidelines

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23
Q

To follow the Frazer guidelines, what 5 critiera must the patient meet?

A

1) Mature and intelligent enough to understand treatment

2) Can’t be persuaded to discuss with their parents, or let the health professional discuss it

3) Likely to have intercourse regardless of treatment

4) Their physical or mental health is likely to suffer without treatment

5) Treatment is in best interest

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24
Q

What hormone does the intrauterine system (IUS) contain?

A

Levonorgestrel (form of progesterone)

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25
Q

How long is the Mirena coil licensed for in

a) HRT
b) contraception

A

a) 5 years
b) 6 years

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26
Q

When the coil threads cannot be seen or palpated, what 1st line investigation is required?

A

US

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27
Q

After female sterilisation, how long is alternative contraception required?

A

Until the next menstrual period - as an ovum may have already reached the uterus during that cycle, ready for fertilisation.

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28
Q

What is involved in a vasectomy?

A

This involves cutting the vas deferens, preventing sperm travelling from the testes to join the ejaculated fluid. This prevents sperm from being released into the vagina, preventing pregnancy.

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29
Q

After male sterilisation, how long is alternative contraception required?

What is required before a vasectomy can be relied upon for contraception?

A

2 months after

Testing of the semen to confirm the absence of sperm is necessary before it can be relied upon for contraception.

Semen testing is usually carried out around 12 weeks after the procedure, as it takes time for sperm that are still in the tubes to be cleared. A second semen analysis may be required for confirmation.

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30
Q

How long after taking EllaOne (ulipristal acetate) must you wait before taking COCP/POP?

A

5 days

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31
Q

What are the 2 major contraindications with ulipristal acetate?

A

1) breastfeeding
2) severe asthma

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32
Q

How long should breastfeeding be avoided after taking ulipristal acetate?

A

1 week - milk should be expressed and discarded

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33
Q

How soon after unprotected sex should the copper coil be inserted?

A

5 days within UPSI or up to 5 days after estimated date of ovulation

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34
Q

What dose of levonorgestrel is given as emergency contraception?

A

1.5mg single dose (3mg if BMI >26)

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35
Q

Mx of all patients with 2ary dysmenorrhoea?

A

Refer to gynae for further investigations

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36
Q

What is offered 1st line in the mx of dysmenorrhoea?

A

NSAIDs - inhibit prostaglandin synthesis (one of the main causes of dysmenorrhoea)

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37
Q

When is cervical ectropion more common?

A
  • during pregnancy
  • on COCP
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38
Q

How long after fitting a Mirena coil does it take to become effective?

A

7 days

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39
Q

Stepwise mx of PMS?

A

1) Lifestyle e.g. sleep, exercise, smoking, alcohol, regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates

2) COCP (w/ drospirenone)

3) SSRI (severe symptoms) - can be taken continuously or just during luteal phase)

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40
Q

What contraceptive methods are indicated in transgender men (assigned female at birth) who are undergoing testosterone therapy?

A

IUD or barrier (no hormones as would interact with testosterone)

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41
Q

What type of bacteria is chlamydia trachomatis?

A

Gram negative obligate intracellular bacteria

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42
Q

How can chlamydia present in a newborn? (2)

A

1) Pneumonia

2) Neonatal conjunctivitis (ophthalmia neonatorum)

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43
Q

What 2 types of swabs are used in sexual health testing?

A

1) Charcoal swabs

2) Nucleic acid amplification test (NAAT) swabs

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44
Q

What is NAAT testing used to test specifically for?

(2)

A

1) Chlamydia
2) Gonorrhoea

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45
Q

In women, a NAAT can be performed on what 3 methods of sample collecting?

A

1) Vulvovaginal swab (a self-taken lower vaginal swab)

2) Endocervical swab

3) First-catch urine sample

The order of preference is endocervical, vulvovaginal, and then urine.

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46
Q

If gonorrhoea is suspected or demonstrated on a NAAT test, what happens next?

A

An endocervical charcoal swab is required for microscopy, culture and sensitivities.

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47
Q

1st line management for uncomplicated chlamydia?

A

Doxycycline (oral) 100mg 2x a day for 7 days

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48
Q

Contraindications for doxycycline in treatment of chlamydia?

(2)

A

1) Pregnancy
2) Breastfeeding

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49
Q

Alternatives options for doxycycline in treatment of chlamydia incases of pregnancy/breastfeeding?

A

Macrolides e.g. erythromycin

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50
Q

When is a test of cure recommended for chlamydia?

(3)

A

1) rectal cases
2) in pregancy
3) symptoms persist

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51
Q

What is Lymphogranuloma venereum (LGV)?

A

A condition affecting the lymphoid tissue around the site of infection with chlamydia.

Caused by a serotype of Chlamydia trachomatis.

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52
Q

Who does LGV most commonly present in?

A

MSM presenting with anal discharge and pain, or anyone presenting with rectal chlamydia.

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53
Q

Management of LGV?

A

Requires longer (21 days) course of Abx

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54
Q

What is a crucial differential diagnosis of Chlamydial Conjunctivitis and should always be tested?

A

Gonococcal conjunctivitis –> can result in severe complications such as vision loss if the bacteria penetrate further and cause corneal ulceration and scarring

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55
Q

What type of bacteria is Neisseria gonorrhoeae?

A

Gram -ve diplococcus

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56
Q

Why should a standard charcoal endocervical swab also be taken from the symptomatic area in all patients with symptoms of gonorrhoea?

A

This is to test for sensitivities and monitor patterns of antimicrobial resistance.

NAAT just tests for the presence of the bacteria.

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57
Q

1st line management for gonorrhoea?

A

IM injection 1g ceftriaxone

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58
Q

what class of antibiotic is ceftriaxone?

A

cephalosporin

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59
Q

what class of antibiotic is cirpofloxacin?

A

fluoroquinolone

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60
Q

Why should ALL patients with gonorrhoea have a follow up ‘test of cure’ 2 weeks after treatment?

A

given the high abx resistance

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61
Q

Causative organism of syphilis?

A

Treponema pallidum

62
Q

What is the incubation period of syphilis (i.e. time from inital infection to symptom presentation)?

A

Approx 21 days

63
Q

What type of bacteria is Treponema pallidum?

A

Spirochete

64
Q

Congenital syphilis (i.e., present from birth) can be broken down into two stages.

What are these?

A

Early congenital –> presents in those <2 y/o

Late congential –> presents in those >2 y/o

65
Q

How does PRIMARY syphilis present?

A

Development of an indurated painless ulcer (chancre) on the genitals.

66
Q

How does secondary syphilis typically present?

A

Widespread non-pruritic maculopapular rash (if involving the soles and palms, is almost pathognomonic for syphilis)

Condylomata lata (grey wart-like lesions around the genitals and anus)

Low-grade fever

Lymphadenopathy

Alopecia (localised hair loss)

Oral lesions

67
Q

What rash is almost pathognomonic for syphilis?

A

Widespread non-pruritic maculopapular rash involving palms and soles

68
Q

When does tertiary syphilis occur?

A

occurs >2 years following infection

69
Q

Features of 3ary syphilis?

A
  • Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
  • Aortic aneurysms
  • Neurosyphilis
70
Q

What is Argyll-Robertson pupil? What is it found in?

A

A specific finding in neurosyphilis.

It is a constricted pupil that accommodates when focusing on a near object but does not react to light.

They are often irregularly shaped.

71
Q

What is the mainstay of diagnosis of syphilis?

A

Serology

72
Q

In patients with lesions, how can syphilis be diagnosed?

A

syphilis PCR swab of the lesion

73
Q

What is the window period of syphilis?

A

12 weeks

Testing should be repeated at least 12 weeks after last exposure

74
Q

1st line pharmacological management of syphilis?

A

Single deep IM dose of benzathine benzylpenicillin

75
Q

What is a Jarisch-Herxheimer reaction?

A

A Jarisch-Herxheimer (JH) reaction can occur following the initial treatment of syphilis in some patients.

This phenomenon causes a sepsis-like picture due to the release of toxins from treponemal bacterium breakdown.

76
Q

Which sensory nerve ganglia is affected in genital herpes?

A

Sacral nerve ganglia

77
Q

How should a PCR swab of HSV lesion be taken?

A

The lesion should be BURST and a swab taken from the BASE of the ulcer.

Lesions must be present for HSV testing to occur.

78
Q

When is the risk of neonatal HSV increased?

A

If mother becomes infected in 3rd trimester

79
Q

What should be excluded if genital wart lesions appear atypical or suspicious?

A

Oncogenic HPV type

80
Q

What risk factor is known to increase the risk of genital wart recurrence?

A

Smoking

81
Q

Topical treatments for genital warts?

A

1) Topical podophyllotoxin (Warticon® and Condyline®)

2) Topical imiquimod (patients should be made aware that this damages condoms)

82
Q

What are some physical ablation therapy options for genital warts?

A

1) Cryotherapy
2) Surgical excision

83
Q

What is trichomoniasis?

A

STI caused by a parasite/protozoan - (Trichomonas vaginalis)

84
Q

How is vaginal discharge typically described in trichomoniasis?

A

Frothy and yellow-green, although this can vary significantly. It may have a fishy smell.

85
Q

What can examination of the cervix in trichomoniasis reveal?

A

Strawberry cervix

86
Q

Vaginal pH in trichomoniasis?

A

Raised pH (>4.5)

87
Q

Where should swabs for trichomoniasis be taken from in women?

A

Posterior fornix of vagina (behind cervix)

88
Q

Management of trichomoniasis?

A

Metronidazole

89
Q

How long should alcohol be avoided for following treatment with metronidazole?

A

72h

90
Q

What bacteria can cause non-gonococcal urethritis?

A

Mycoplasma genitalium

91
Q

what is the gold standard for diagnosis of mycoplasma genitalium?

A

NAAT

92
Q

1st line management of uncomplicated Mycoplasma genitalium?

A

1) Doxycycline 100mg twice daily for 7 days

2) Followed by azithromycin 1g as a single dose then 500mg daily for 2 days

93
Q

What human cells does HIV infect?

A

CD4+ helper cells

94
Q

What are the 2 types of HIV?

A

HIV-1 (most common)
HIV-2 (mainly found in west africa)

95
Q

What is the protein on the surface of HIV that binds to CD4+?

A

gp120

96
Q

What CD4+ cell countis sufficient for a diagnosis of AIDS?

A

<200

97
Q

Give some examples of AIDS-deining illnesses

A

1) Kaposi’s sarcoma
2) PCP
3) CMV infection
4) Candidiasis
5) Lymphomas
6) TB
7) Hairy leukplakia

98
Q

What is the treatment aim of ART in HIV? (2)

A

1) undetectable viral load
2) normal CD4+ count

99
Q

When must PEP be commenced after HIV exposure?

A

within 72h

100
Q

What is the most common life-threatening opportunistic infection in AIDS?

A

Pneumonia

101
Q

Which mode of delivery is used in mothers with the following HIV viral loads:

a) under 50 copies/ml
b) over 50 copies/ml
c) over 400 copies/ml

A

a) vaginal
b) consider a pre-labour c-section
c) pre-labour c-section is recommended

102
Q

What is given as an infusion during labour and delivery if the HIV viral load is unknown or above 1000 copies/ml?

A

IV zidovudine

103
Q

when is IV zidovudine given during labour and delivery?

A

if viral load is unknown or >1000

104
Q

Can HIV be transmitted during breastfeeding?

A

Yes

ALWAYS avoid breastfeeding

105
Q

Investigation window period for chlamydia?

A

2 weeks

106
Q

When is a test of cure for gonorrhoea recommended?

A

Pregnancy

107
Q

Discharge in men in gonorrhoea vs chlamydia?

A

Gonorrhoea - urethritis +/- yellow discharge

Chlamydia - urethral discharge typically clear/white

108
Q

What are the 2 most common causes of non-gonococcal urethritis?

A

1) Chlamydia trachomatis

2) Mycoplasma genitalium

109
Q

Does urethral discharge always need investigation?

A

Yes

110
Q

What symptom typically accompanies a chancre?

A

Local lymphadenopathy

111
Q

Management of late latent, CVS and gummatous syphilis?

A

Benzathine penicillin IM for 3 weeks

112
Q

Length of aciclovir treatment in herpes in primary vs recurrent infection?

A

Primary - 10 days
Recurrent - 3 days

113
Q

What systemic symptoms can initial infection with herpes cause?

A
  • dysuria
  • myalgia
  • flu like
  • fever
  • malaise
114
Q

What triad is seen in disseminated gonococcal infection?

A

1) tenosynovitis

2) migratory polyarthritis

3) dermatitis

115
Q

What investigation is standard for diagnosis and screening of HIV?

A

Combination HIV p24 antigen and HIV antibody test

116
Q

What is acute epididymo-orchitis in sexually active younger adults most commonly caused by?

A

Chlamydia

117
Q

Investigation of choice in genital herpes?

A

NAAT tests

118
Q

What determines the risk of HIV transmission following a needle stick injury?

A

Viral load (higher load = higher risk)

119
Q

mx of genital warts:

1) multiple, non-keratinised warts
2) solitary, keratinised warts

A

1) topical podophyllum
2) cryotherapy

120
Q

What is the most common and important viral infection in solid organ transplant recipients?

A

CMV

121
Q

Most common cause of epididymo-orchitis in individuals with a low STI risk (e.g. married male in 50s, wife only partner)?

A

E. coli (enteric organisms)

122
Q

Mx of herpes if contracted during 3rd term?

A

Oral aciclovir 400 mg TDS (three times daily) until delivery

IV aciclovir for the mother or for the infant is only recommended if there has been a PPROM or a spontaneous vaginal delivery in the presence of a 1ary herpes infection.

123
Q

Which type of pneumonia typically causes desaturation on exertion and a normal CXR?

A

PCP

124
Q

What is the component of the healthy vaginal bacterial flora?

A

Lactobacilli (produce lactic acid –> keep pH low)

125
Q

What is the ideal pH of the vaginal canal?

A

3.8 - 4.5

126
Q

What anaerobic bacteria causes BV?

A

Gardnerella vaginalis

127
Q

At what vaginal pH does BV occur?

A

> 4.5

128
Q

What is the most likely cause of discharge changes in post-menopausal women?

A

Atrophic vaginitis (reduction in oestrogen causes irritation)

129
Q

Describe discharge & odour in

a) BV
b) Candida
c) Trichomonias vaginalis

A

a) thin & watery, fishy

b) thick & white, no odour

c) green & frothy, fishy

130
Q

Describe vulval irritation in

a) BV
b) Candida
c) Trichomonias vaginalis

A

a) nil

b) itching, irritation & pain

c) itching, soreness & dysuria

131
Q

Describe vaginal pH in

a) BV
b) Candida
c) Trichomonias vaginalis
d) Physiological

A

a) >4.5

b) <4.5

c) >4.5

d) <4.5

132
Q

What is seen on microscopy in BV?

A

‘Clue cells’ - epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.

133
Q

A diagnosis of BV can be made based on bedside investigations using what 2 criteria?

A

1) Amsel criteria

2) Hay/Ison criteria

134
Q

What are the Amsel criteria?

A

1) Homogeneous discharge on clinical examination

2) Microscopy showing clue cells

3) Fishy odour on adding 10% potassium hydroxide to vaginal fluid

4) Vaginal pH >4.5

135
Q

What is the Abx of choice in treating BV?

A

Metronidazole (specifically targets anaerobic bacteria)

136
Q

Complications of BV?

A

Higher risk of STIs

137
Q

what hormonal changes can increase risk of candidiasis?

A

Increased oestrogen e.g. pregnancy

138
Q

What antifungal agent is present in topical antifungal creams & vaginal pessaries for candidiasis?

A

Clotrimazole

139
Q

What antifungal agent is present in oral medications for candidiasis?

A

Fluconazole

140
Q

Contraindications of oral antifungal tablets for candidiasis?

A

pregnant women, women at risk of pregnancy, and breastfeeding women.

141
Q

What is Fitz-Hugh-Curtis Syndrome?

A

A complication of PID (10%).

Caused by inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum.

Presentation –> RUQ pain that can be referred to the right shoulder tip if there is diaphragmatic irritation.

142
Q

What may Fitz-Hugh-Curtis Syndrome be confused with?

A

Cholecystitis

143
Q

When are antibiotics started in PID?

A

Empirically

144
Q

A typical outpatient regime for PID:

A

Combination of:

1) Doxycycline
2) Metronidazole
3) Ceftriaxone

145
Q

What should you always look for signs of in PID?

A

Sepsis !

146
Q

In which cases of PID require admission for IV Abx?

A

1) sepsis
2) pregnancy

147
Q

1st line for mx of non-pregnant women with thrush?

A

Single dose of oral fluconazole

148
Q

Mx of BV in pregnant women?

A

Oral metronidazole (low dose) for 7 days

149
Q

What is chancroid?

A

A tropical disease caused by Haemophilus ducreyi.

It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement.

150
Q

Features of chancroid?

A
  • painful genital ulcers
  • unilateral inguinal lymph node enlargement
  • ulcers have sharply defined, ragged, undermined border
151
Q

When should a positive HIV test be repeated?

A

Around 12 weeks time

Start antiretroviral therapy in the meantime

152
Q
A

Yr 5 - Obs & Gynae (9 decks)

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