Revision Session Questions (Sexual Health X HIV)

Question 1

Answer 1

pH of 6 is abnormal (normal is 4.5) - leaves two differentials: BV and trichomonasis

Green discharge: trichomonas
- also if frothy
- cervix is normally very inflammed and red

Question 2

Dx? [1]

Answer 2

Trichomonosis

Question 3

What else needs to be done to treat this patient after their diagnosis [+]

Think OSCE style

Answer 3

• Sexual history
• Screen for other STIs - including bloods (HIV and syphilis)
• Discuss partner treatment and abstinence until treatment is completed
• Plan for follow up
• Advice for STI prevention in future - regular STI screens / screening with new partners
• Think about window periods of STIs - may need more tests in the future
• Enquire about condom use - give
• Offer vaccinations

Question 4

Answer 4

DDx: HSV; Syphilis

Answer: Syphilis

Question 5

What needs to be done next for this patient?

Answer 5

1. Full sexual history
2. Treat him and partner
3. Full STI, HIV and HAV, HBV xscreen
4. Discuss vaccinations (mpox; HPV)
5. Future STI screens
6. Discuss condom use (prevents / reduces use of STIs)
7. PrEP and PEP

Question 6

Describe the pathophysiology

Answer 6

White discharge; bubble bath and douche: BV
- caused by overgrowth of anaerobes in vagina
- Bubble baths and douches is changing immediate environment in vagina

Candida would be itchy

NB: BV doesnt always have discharge

Question 7

Answer 7

Early primary genital herpes
- soreness happens before ulcers

Question 8

Answer 8

Candida

Question 9

Answer 9

A - clotrimazole pessary 500mg PV stat and topical Clotrimazole cream

Always first line treatment (in pregnancy and non)

Fluconazole is CI In pregnancy

Wet slide of candida

Question 10

Dx? [1]

Answer 10

BV - clue cells

Question 11

Answer 11

Dx: BV

Tx: Clindamycin

First line is oral metronidazole but shes had a reaction

Question 12

Answer 12

Dx: trichomonasis

Tx: Metrondizole

Strawberry cervix - always trichmonasis

Question 13

Answer 13

Doxycycline

Question 14

Answer 14

Oral acyclovir

Question 15

Answer 15

Secondary syphilis

Question 16

Answer 16

Herpes zoster (shingles)

Question 17

Which groups of patients commonly present with shingles [2]

Answer 17

HIV+
Elderly: poorer immune reponse with age

Question 18

Dx? [1]

Answer 18

gonorrhoea

Question 19

Answer 19

A

Question 20

Answer 20

Scabies

Question 21

Answer 21

Acyclovir

Question 22

Answer 22

Pregnancy is a state of immunosuppresion

Weeky cryotherapy
- podophyllotoxin is CI in pregnancy

Question 23

Answer 23

No tx

Question 24

Answer 24

Dx: molluscum contagosium
No tx - especially in children
Can also treat using cryotherapy

Question 25

Answer 25

Normal CD4 count is: 450-500+
Streptococcus pneumoniae

Question 26

Patient with HIV.

What is the most likely dx? [1]

Answer 26

DDx: as they both cause cavitational pneumonias.
Staph aureus
TB

Question 27

Answer 27

Because he is otherwise well: means he can’t have EBV etc

He has persistent generalised lymphadenopathy - common presenting complaint of HIV+

Question 28

Answer 28

Non-Hodgkin lymphoma
- is the most common type of lymphoma in HIV

Question 29

Which one is TG and which is lymphoma?

Answer 29

A: TG
B: lymphoma

Question 30

Answer 30

Dementia