Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

DipGUM 2025 > systemic manifestations > Flashcards

systemic manifestations Flashcards

1
Q

STEI

Symptoms of giardia duodenalis

A

40% asymptomatic
small bowel infection -> profuse watery diarrhoea, steatorrhoea, malabsorption, flatulence, nausea and vomiting, weight loss

lactose intolerance can complicate Giardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

STEI

Dx Giardia

A

PCR recommended

culture may need repeating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

STEI

RX giardia

A

Metronidazole 2g od 3d or 400mg tds 5-7d

notifiable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

STEI

PN giardia

A

4w lookback, treat if symptomatic.

only test asymtomatic contacts in refractory giardia where re-infection maybe occuring, treat contact if positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

STEI

Name some causes of sexually transmitted procto colitis

A

Bacterial: shigella, campylobacter, STEC, salmonella
Protozoal: entomoeba histolytica

all notifiable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

STEI

Name some complications of STEI

A

SARA: shigella and campylobacter
HUS: shigella and STEC
Guillain Barre: campylobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

STEI

What % of entomoeba histolytica cases are symptomatic

A

10% = amoebic dysentry and liver abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

STEI

investigation of entomoeba histolytica

A

PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

STEI

Rx entomoeba histolytica

A

systemic treament: metronidazole 500mg tds 5d, kills parasite
intraluminal treatment: paromomycin 500mg tds 7d, clears cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PN entomoeba histolytica

A

treat all contacts, both symptomatic and asymptomatic (but lookback unknown)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

STEI

Define proctocolitis

A

inflammation extending >15cm from anus into the sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

investigation of diarrhoea in MSM

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

STEI

Usual management of bacterial proctocolitis

A

Supportive: fluids / ORT
avoid antibiotics - high resistance/can trigger HUS
avoid antimotility agents

May need admission if unwell

consider antibiotics if in hospital + fever + diarrhoea +/- co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

STEI

Causes of proctitis

A

gonorrhoea, CT, LGV, Syphilis, Mpox, Mgen

only Mgen is notifiable
severe symptoms suggest LGV
inflammatory proctitis may be part of 2y syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

STEI

Ix proctitis

A

perianal ulcers = direct tests: DG, PCR syphilis, HSV, Mpox
proctoscopy if possible = slide for gram stain, GC plate, chlamydia (LGV), gonorrhoea, HSV, Mpox
Serology = HIV syphilis HepABC*

*depending on history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

rectal slide gram stain PMNL interpretation

A

> 10 PMNLs on rectal slide in MSM predicts LGV
rectum doesn’t usually have inflammatory cells present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

STEI

Mx proctitis

A

if severe:
Ceftriaxone 1g im
doxycycline 100mg bd 21d (can stop if LGV neg)
aciclovir 400mg tds 5-10d

Review at 7d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

STEI

Follow up of proctitis

A

If not improving at 7 days and tests negative, check Mgen and consider referral to gastro
if chlamydia neg, stop doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

STEI

general advice for patients with STEI

A

Avoid sex for 7d / until symptoms resolved
avoid swimming pools/saunas/jacuzzi for 2w
avoid work for 48h if working with people or food (in some cases longer/until microbiological clearance - as directed by public health)
hygiene advice, hand washing: toilet/food prep, cleaning, avoid sharing towels etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

STEI

Summary of PN in STEI

A

generally lookback = 4w, no testing, just treat symptomatic contacts as for the index.
exception
confirmed giardia - always treat index, test contacts if refractory giardia and treat if +ve
entomoeba histolytica - always treat index and contacts (although lookback time is not known!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

rectal incections

Advice on how to take an anorectal self swab

A

wash hands
gently insert the swab into the anus 2-3cm
rotate for 5-10 seconds, making sure the swab touches this sides of the anal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EO

What STIs cause EO

A

chlamydia
gonorrhoea
Mgen: plausible but evidence lacking

not ureaplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

EO

Give some factors that increase the risk of EO due to enteric organisms

A

insertive anal sex
instrumentation of lower urinary tract
abnormalities of the lower urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EO

What is the significance of the 35y cut off in assessment of EO

A

<35y STI more likely causal, >35y enteric organism more likely causal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
# EO Brucellosis, is more common in which parts of the world
Mediterranean, Middle East ## Footnote unpasturised milk, farm animals, meat fever, night sweats, lethargy and EO in up to 20%
26
# EO How do you test for brucellosis
serology
27
# EO How do you test for Mumps
saliva pcr within 6w or serology, IgM suggests acute infection, IgG suggests previous infection or immunisation
28
# EO Which causes of EO are notifiable
Brucellosis, mumps, TB
29
# EO non infective causes of EO
sperm granuloma, vasculitic disorders, bechet's, amiodarone, sarcoidosis, HSP
30
# EO symptoms of EO
unilateral pain / swelling / fever +/- STI or UTI symptoms
31
# EO signs of EO, what is prehn sign
unilateral firm swelling and tenderness of the epididymis, starting with the tail at the lower pole and spreading to the whole epididymis and testis Prehn sign = pain eases with elevation of the testis
32
# EO if torsion can't be excluded, what is the appropriate management
Urgent urology assessment: need surgery as soon as possible to salvage testis No role for USS prior to surgical exploration - can delay surgery and USS dependent on user ability and may be inaccurate ## Footnote ideally within 4-6h,
33
# EO does EO cause infertility?
Relationship between EO and fertility poorly understood. Mumps can reduce fertility (testicular atrophy in 30-50%, of those with bilateral orchitis, 13% will have reduced fertility) ## Footnote maybe because mumps affects the testis more than the epididymis?? just my thoughts
34
# EO Investigations for EO
urethral slide GC culture first pass urine naat chlamydia/gonorrhoea, +/- Mgen (BASHH mgen guideline says consider Mgen for EO, EO guideline says to do Mgen. locally we do check Mgen for EO) urinalysis MSU (unless clearly STI) +/- serology: brucella/mumps +/- USS to assess for complications FULL STI SCREEN
35
# EO Managment of EO, general advice
full explanation / pt info leaflet analgesia, scrotal elevation/support no sex until treated and partner treated if needed Quinolone counselling if using
36
# EO Management of EO due to STI
1g ceftriaxone im plus doxycycline 100mg bd 10-14d (if gonorrhoea unlikely can omit cef or use ofloxacin 200mg bd 14d) ## Footnote Mgen moxifloxacin 400mg od 14d
37
# EO Management of EO due to enteric organism
ofloxacin 200mg bd 14d or levofloxacin 500mg od 10d or co-amoxiclav 125/500 tds 10d if quinolones contraindicated
38
Managment of EO: STI and enteric organisms likely eg MSM IAI
ceftriaxone 1g im plus ofloxacin 200mg bd 14d
39
# EO EO follow up
72h review: symptoms improving? can be slow to resolve, swelling reduced by 3m in 80% 2w: comp/PN/symptoms
40
# EO EO PN
STI screen for all contacts treat for CT or GC if confirmed in the index lookback 4w, (2w if GC)
41
# PID Which of the following factors increase the risk of PID? younger age pregnancy smoking condoms spermicide douching IUCD fitting
increased risk: younger age, smoking, douching, 4-6w after IUCD fitting reduced risk: pregnancy, condoms, spermicide
42
# PID Symptoms and signs
symptoms: LAP, discharge, dyspareunia, dysmenorrhoea, irregular bleeding signs: fever, lower abdo tenderness, cervical motion/uterine/adnexal tenderness
43
# PID Risk of infertility with PID
Relates to severity and frequency of PID infections 1x PID = 10% 2xPID = 20% 3xPID = 40%
44
# PID What is fitz hugh curtis syndrome
Perihepatitis associated with PID => RUQ pain, shoulder tip pain, hiccups more common in adolescents / with CT PID Standard treatment, no evidence that additional treatment is beneficial
45
# PID Other possible complications
tubo-ovarian abscess chronic pelvic pain ectopic pregnancy peri-appendicitis
46
# PID How to diagnose PID
sexually active female + LAP + tenderness on bimanual + negative pregnancy test + no other cause for symptoms identified ## Footnote low threshold for treatment, increased risk of complications with delayed treatment
47
# PID what's the PPV of PMNLs on gram stain cervix slide for PID
17%, poor
48
# PID what's the NPV of PMNLs on gram stain cervix slide for PID
95%, good
49
# PID when to admit for iv treatment?
temp >38 tubo-ovarian abscess peritonitis/sepsis pregnant not responding to oral therapy can't exclude a surgical emergency
50
# PID Recommended outpatient treatment of PID
Ceftriaxone 1g im, doxycycline 100mg bd 14d, metronidazole 400mg bd 14d ## Footnote Quinolone regimes have the same grade of evidence 1A but 2nd line due to potential side effects unless confirmed Mgen PID, when there is no alternative to moxifloxacin
51
# PID Alternative regime for treatment of PID
Ceftriaxone 1g im, azithromycin 1g po weekly for 2w ## Footnote Alternative regime for treatment of PID, with lower evidence grade of effect 2B
52
# PID Considerations if PID with IUCD
* If mild to moderate can leave IUCD in situ initially, review at 48-72h and remove IUCD if not improving
53
# PID PN for PID
lookback is 6m screen and offer partners treatment with doxycycline 100mg bd 7d (or for specific infections if identified)
54
# CPPS symptoms
pain - pelvis/genitals urinary symptoms - voiding/storage sexual problems - erectile dysfunction psychological - anxiety/stress/reduce QOL
55
# CPPS possible cause of CPPS
anxiety-> increased pelvic muscle tone->pain-> anxiety etc
56
# CPPS management of CPPS
multimodal approach pain management - simple analgesics/neuropathic pain meds pscyhol - coping skills, address anxieties pelvic floor relaxation exercises and physio +/- Rx LUTs eg alpha blocker +/- Rx antibiotics, contraversial, as a one off Referral to urologist may be appropriate to exclude possible causes and co-ordinate management
57
# SCROTAL SWELLINGS Scrotal EXAMINATION
Unilateral or bilateral? some testicular tumours are bilateral Cannot get above? Inguinal hernia reducible? hernia testis separate? transilluminable? hydrocele (testis not separate) epididimal cyst (testis separate) tender? torsion/EO/haematocele non tender? tumour
58
# SARA definition
sterile arthritis triggered by infection at a distal site
59
# SARA microbiological triggers
chlamydia (implicated in 2/3 cases) gonorrhoea Mgen: new evidence suggests a link STEI: shigella/campylobacter | NGU is the most common trigger presentation ## Footnote Ureaplasma: no evidence to show causal link
60
# SARA Risk factors
male HLA-B27 PMH/FH: iritis/IBD/psoriasis/SAPHO FH: seronegative arthritis ## Footnote SAPHO = synovitis, acne, pustulosis, hyperostosis, osteitis
61
# SARA time between infection and onset of SARA
SARA typically presents 2 weeks after infection (STI/STEI)
62
# SARA classic triad of symptoms
arthritis, urethritis and conjunctivitis | most patients do not present with this triad
63
# SARA MSK features
asymetrical oligoarthritis (1-5 joints) - lower limb sacroilitis enthesitis dactylitis
64
# SARA Eye features
conjunctivitis iritis/anterior uveitis scleritis episcleritis ## Footnote refer urgently to opthalmology for slit lamp examination and management
65
# SARA skin/mucosal features
keratoderma blenorrhagica 33% pustular psoriatic type rash, often on soles erythema nodosum nail dystrophy circinate balanitis / vulvitis oral ulcers/geographical tongue
66
# SARA what % of patients have no identifiable trigger
25% e.g. preceeding asymptomatic infection
67
# SARA investigations suggested for all patients
Naat for chlamydia and gonorrhoea micro urethra/cervix gonorrhoea culture urinalysis inflammatory markers eg FBC, CRP/ESR +/- Mgen +/- stool tests
68
# SARA Is HLA-B27 testing advised for all patients
No
69
# SARA how long do symptoms of SARA usually last
Usually self limiting - lasts 2-6m 15-30% progressive (assoc with HLA B27) recurrence is common up to 50%
70
# SARA General management advice
information/pil no sex until treated (partner too if indicated) avoid future triggers; condoms / careful with food triggers
71
# SARA Is early antibiotic treatment of chlamydia related SARA beneficial?
Not clear if antibiotics influence disease course, may reduce recurrence risk ## Footnote standard antibiotic treatment regimens advised

DipGUM 2025 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions