SGL

Question 1

Common infective causes of vaginitis

Answer 1

candidiasis, trichomoniasis

Question 2

Common infective causes of cervicitis

Answer 2

Gonorrhoea, chlamydia, trichomoniasis, candidasis

Question 3

Common infective causes of urethritis

Answer 3

Gonorrhoea, chlamydia, trichomoniasis

Question 4

Bacterial vaginosis diagnosis

Answer 4

3 out of 4 of:

o pH > 4.5
o Whiff test (10% KOH)
o Homogeneous discharge
o Clue cells – vaginal epithelial cells studded with bacteria

Question 5

Clinical features of vaginal candidiasis

Answer 5

o Red, inflamed vagina, vulva
o Itching and burning
o Thick white discharge with adherent curd-like patches

Question 6

Commonest STI and clinical features

Answer 6

Chlamydia

o Purulent discharge from cervix (inflamed), and urethra, or rectum
o Infection of pelvix ascend to pelvic organs i.e. PID, urethritis

Question 7

Antibodies measured in serum for syphillis

Answer 7

o Non-treponemal (non-specific)
♣ AB to cardiolipin, modified by treponemal infection
♣ Tests are Rapid Plasma Reagin (RPR), Venereal Disease Reference Laboratory (VDRL)
o Treponemal (specific)
♣ Enzyme Immunoassay for total antibody (EIA)
♣ Chemiluminescent Microparticle Immunoassay for total antibody (CMIA)
♣ Treponema pallidum Particle Agglutination (TPPA)
♣ Fluorescent Treponemal Antibody – Absorbed (FTA-Abs)
♣ FTA-Abs-IgM (as above, but for IgM only)

Question 8

Which antibodies drop post infection?

Answer 8

non treponemal AKA non-specific antibodies

Question 9

Cervical cancer subtypes

Answer 9

SCC 80%
Precursor lesions = LSIL (HPV+ CIN1) + HSIL (CIN2+3)

and adenocarcinoma 20%
Precursor lesion = AIS

Question 10

Investigations for cervical cancer

Answer 10

Pap smearbrush inserted into cervix, smeared onto slide.ThinPrep compared to conventional smear. Changing to first Pap smear at 25 years, and then every 5yrs after that Colposcopy  identifies exact site/extent of lesion. “microscope on a stand” enables direct visualisation of
cervix
LLETZ: large loop excision of transformational zone - wire loop with current running through it

Cone biopsy: surgically removes the abnormal area

Question 11

If a patient has HPV effect with LSIL (low grade lesion), what should the next step be?

Answer 11

More frequent pap smears

Question 12

Squamous cells with increased nuclear:cytoplasmic ratio and are hypo chromatic are associated with which condition?

Answer 12

ICN 2 or 3 = high grade lesion

Question 13

If a patient has HSIL, what should the GP recommend?

Answer 13

Colposcopy and biopsy

Question 14

Difference between CN3 and SCC?

Answer 14

SCC has invasion through basement membrane

Question 15

Usual presenting symptoms for endometriosis

Answer 15

Pelvic pain 
Infertility
Dysmenorrhoea
Cramps
Dyspareunia

Question 16

Where can endometriosis occur?

Answer 16

Peritoneum, fallopian tube and cervix

Question 17

Pathophysiological mechanism of endometrial tissue occurring outside the uterus

Answer 17

1. Retrograde menstruation→ endometrial tissue moves backwards in to the fallopian tube and the peritoneum
2. Metaplastic alteration →peritoneal cells transform into endometrial tissue
3. Vascular or lymphatic spread

Question 18

3 Main components of teratoma

Answer 18

Ectodermal tissue - skin + sebaceous glands

Mesodermal tissue - cartilage, bone, smooth muscle

Endodermal tissue - GIT epithelium, respiratory epithelium

Question 19

Chorionic villi which look like clusters of grapes

Answer 19

Complete hydatidiform mole

Question 20

Two types of non specific treponemal tests

Answer 20

RPR - rapid plasma reagin
VDRL - venereal disease reference lab

In response to treatment you would expect a 4 fold drop in RPR/VDRL titre

Question 21

Specific antibody treponemal tests

Answer 21

EIA Enzyme Immunoassay for total antibody

CMIA Chemiluminescent Microparticle Immunoassay for total antibody

TPPA Treponema pallidum Particle Agglutination

FTA-Abs Fluorescent Treponemal Antibody – Absorbed

FTA-Abs-IgM As above, but for IgM only

Question 22

HIV markers in the blood

Answer 22

HIV antibody

HIV antigen p24