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phase 3a medicine > Women's health > Flashcards

Women's health Flashcards

1
Q

Where does fertilisation usually occur?

A

the ampulla of the fallopian tube

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2
Q

What are the 6 stages of fertilisation?

A

Capacitation
Acrosome reaction
Adhesion and entry
Cortical reaction
Meiosis II
Syngamy

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3
Q

What is capacitation?

A

final stage of sperm maturation - involves exposure of receptor sites
involved in zona pellucida penetration.

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4
Q

What is the acrosome reaction?

A

loss of the acrosome cap on the head of the sperm cell leads to
release of lytic enzymes, which allows the sperm to penetrate the zona pellucida.

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5
Q

what is the cortical reaction?

A

modification of the zona pellucida to prevent polyspermy, induced by
membrane fusion and mediated by cortical granules

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6
Q

what is syngamy?

A

the male and female pronuclei replicate DNA and shed their nuclear
membranes as they move toward one another, before aligning at a common metaphase
plate and undergoing mitosis.

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7
Q

when does the blastocyst implant in the endometrium?

A

day 6-7

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8
Q

what is gastrulation and when does it occur?

A

week 3
formation of the trilaminar disc (endoderm, mesoderm, ectoderm) from the primitive streak

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9
Q

when does neurulation occur and what is it?

A

week 4- the development of a neural tube from the ectoderm

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10
Q

what week is thought to be the threshold of viability?

A

week 23

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11
Q

what is placenta praevia?

A

placenta covers the internal os of the cervix

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12
Q

what is a low-lying placenta?

A

placenta lies within 20 mm of the internal os (but does not cover it)

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13
Q

what are the risk factors for placenta praevia?

A

● Previous caesarean section
● IVF pregnancy
● Previous placenta praevia
- older maternal age
- maternal smoking
- assisted reproduction
- uterine abnormalities e.g. fibroids

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14
Q

what can trigger bleeding in placenta praevia?

A

○ Sexual intercourse
○ Vaginal examination
○ Cervical dilatation in labour

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14
Q

what investigations should be done following a diagnosis of antepartum haemorrhage?

A
  1. Full blood count, group + save
  2. Kleihauer test (for fetomaternal haemorrhage) in Rhesus -ve women
  3. Transvaginal / transabdominal ultrasound
  4. CTG for foetal monitoring
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15
Q

what are some differentials for antepartum haemorrhage?

A

● Placental abruption
● Onset of labour
● Cervical ectropion
● Vasa praevia

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16
Q

what drug can be given for low lying placenta or placenta praevia?

A

corticosteroids given between 34 and 35+6 weeks, helping organs mature doe to risk of preterm delivery

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17
Q

what additional scans should a woman with low lying/ placenta praevia receive?

A

transvaginal ultrasound at 32 and 36 weeks

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18
Q

what is vasa praevia?

A

Malformation of foetal vessels (umbilical vein + arteries), leading them to run through
placental membranes instead of the umbilical cord.

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19
Q

what is mortality of vasa praevia if SROM occurs?

A

foetal mortality is 60%

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20
Q

how can vasa praevia be detected?

A

● Antenatal: transvaginal ultrasound scan
● Labour: vaginal examination (palpable foetal vessels overlying os).

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21
Q

what is the management of vasa praevia antenatally?

A

○ Corticosteroids at 32 weeks due to high risk of prematurity
○ Elective CS (34-36 weeks, although optimal timing is contested).

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22
Q

what is the management of vasa praevia if undetected into labour?

A

Cat 1 C section

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23
Q

what is placenta accreta?

A

abnormal invasion of the placental villi through the decidua
leading to adherence to the myometrium.

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24
Q

what is placenta increta?

A

abnormal invasion of the placental villi through the decidua and into the myometrium, through to the outer serosa.

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25
Q

what is placenta percreta?

A

abnormal invasion of the placental villi through the entire
uterine wall; it may then invade other organs.

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26
Q

what are the risk factors for placenta accreta?

A

Previous placenta accreta
Previous endometrial curettage procedures (e.g. for miscarriage or abortion)
Previous caesarean section
Multigravida
Increased maternal age
Low-lying placenta or placenta praevia

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27
Q

what is the management of placenta acreta?

A

give steroids and C section 35-36+6 weeks
can include hysterectomy, uterus preservation or expectant management (leaving placenta inside)

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28
Q

what is placental abruption?

A

Premature separation of the placenta from the decidua.

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29
Q

how does placental abruption present?

A

Sudden onset severe abdominal pain that is continuous
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension and tachycardia)
Abnormalities on the CTG indicating fetal distress
Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage

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30
Q

what is a concealed placental abruption?

A

Concealed abruption is where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity. The severity of bleeding can be significantly underestimated with concealed haemorrhage.

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31
Q

What is pregnancy induced hypertension?

A

new-onset hypertension, developing after 20 weeks gestation.

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32
Q

What is pre-eclampsia?

A

new-onset hypertension associated with proteinuria or systemic
features*, developing after 20 weeks gestation.

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33
Q

what triad is seen in pre-eclampsia?

A

Hypertension
Proteinuria
Oedema

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34
Q

What is eclampsia?

A

Seizures occurring as a result of pre-eclampsia.

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35
Q

what causes pre-eclampsia?

A

Pre-eclampsia is caused by high vascular resistance in the spiral arteries and poor perfusion of the placenta. This causes oxidative stress in the placenta, and the release of inflammatory chemicals into the systemic circulation, leading to systemic inflammation and impaired endothelial function in the blood vessels.

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36
Q

what are the high risk factors for pre-eclampsia?

A

Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune conditions (e.g. systemic lupus erythematosus)
Diabetes
Chronic kidney disease

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37
Q

what are moderate risk factors for pre-eclampsia?

A

Older than 40
BMI > 35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia

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38
Q

which women would be offered aspirin from 12 weeks to prevent pre-eclampsia?

A

women with one high-risk factor or more than one moderate-risk factors.

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39
Q

what are the symptoms of pre-eclampsia?

A

Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper abdominal or epigastric pain (this is due to liver swelling)
Oedema
Reduced urine output
Brisk reflexes

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40
Q

how can pre-eclampsia be diagnosed?

A

Systolic blood pressure above 140 mmHg
Diastolic blood pressure above 90 mmHg
PLUS proteinuria, organ dysfunction or placental dysfunction

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41
Q

when would magnesium sulphate be given in pre-eclampsia?

A

during birth and in the 24 hours after or when there are seizures, to relieve seizures

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42
Q

what is HELLP Syndrome?

A

Complication of pre-eclampsia and eclampsia involving:
Haemolysis
Elevated Liver enzymes
Low Platelets

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43
Q

what is gestational diabetes mellitus?

A

Chronic hyperglycemia and insulin resistance due to pregnancy.

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44
Q

what are the maternal complications of GDM?

A

○ Pre-eclampsia
○ Chronic type 2 diabetes (60%)
○ Increased risk of cardiovascular disease

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45
Q

what are the foetal complications of GDM?

A

○ Macrosomia, leading to shoulder dystocia
○ Neonatal hypoglycaemia (due to dependence on maternal hyperglycaemia
raising endogenous foetal insulin).
○ Childhood obesity (2x background risk).
○ Increased risk of metabolic syndrome and associated complications in later life.

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46
Q

what are the risk factors for GDM?

A

● BMI > 30
● Previous macrosomia
● Previous GDM
● Family history of diabetes mellitus
● Ethnicity with high prevalence of diabetes.

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47
Q

what is the first line test for GDM?

A

Fasting blood glucose, followed by 75g carbohydrate drink, with a second blood
glucose test 2 hours later.

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48
Q

What is the diagnostic criteria for GDM?

A

○ Fasting plasma glucose > 5.6mmol/L or
○ 2 hour glucose > 7.8mmol/L

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49
Q

when should insulin be used in GDM?

A

when fasting plasma glucose is >7.0

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49
Q

what is the management of GDM?

A

First Line: 2 week trial of diet, exercise and self-monitoring glucose levels
Second Line: if not successful, metformin

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50
Q

what is the first stage of labour?

A

onset defined by progressive contractions and cervical changes

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51
Q

what is the second stage of labour?

A

from full dilation to delivery of the baby

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52
Q

what is the third stage of labour?

A

from delivery of baby to delivery of placenta and membranes

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53
Q

what is the latent first stage?

A

effacement of cervix to 3 cm

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54
Q

what is the active first stage?

A

dilation from 3 to 10 cm

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55
Q

what is the passive second stage?

A

head descends down pelvis

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56
Q

what is the active second stage?

A

mother bears down

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57
Q

how long should the third stage of labour last?

A

placenta should be delivered within 30 mins of delivery of labour

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58
Q

what are the 7 steps of the second stage of labour?

A
  1. descent
  2. flexion
  3. internal rotation
  4. extension
  5. restitution
  6. external rotation
  7. delivery of shoulders
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59
Q

what 3 things are recorded on the partogram?

A
  1. Progress: cervical dilatation, descent, contractions (frequency and duration)
  2. Foetal wellbeing: heart rate*, amniotic fluid (liquor)
  3. Maternal wellbeing: pulse, blood pressure, temperature, urinalysis
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60
Q

what are the reassuring features of a CTG?

A
  • Baseline heart rate: 110-160
  • Decelerations: absent
  • Accelerations: present
  • Baseline variability: 5-25 bpm
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61
Q

what are decelerations?

A

drops of 15bpm for 15 seconds

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62
Q

what are accelerations?

A

increases of 15 bpm for 15 seconds

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63
Q

what does the Bishop’s score take into account?

A
  1. cervical dilation (cm)
  2. cervical effacement (%)
  3. foetal station
  4. cervical consistency
  5. cervical position
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64
Q

what are the indications for induction of labour?

A

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine foetal death

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65
Q

what is used to induce labour when intrauterine foetal death has occurred?

A

Oral mifepristone (anti-progesterone) plus misoprostol

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66
Q

how does a membrane sweep work?

A

Membrane sweep involves inserting a finger into the cervix to stimulate the cervix and begin the process of labour. It is used from 40 weeks gestation to attempt to initiate labour in women over their EDD.

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67
Q

what is the definition of a delayed first stage of labour?

A

cervical dilatation of less than 2cm in 4 hours.

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68
Q

what is the definition of a delayed second stage of labour?

A

Nulliparous: >2 hour duration of second stage of labour.
○ Multiparous: >1 hour duration of second stage of labour.

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69
Q

what is the definition of a delayed third stage of labour?

A

○ Actively managed (oxytocin injection): >30 minutes without delivery of placenta.
○ Physiological: >60 minutes without delivery of placenta.

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70
Q

what are the 3 factors of delayed labour?

A

Power- uterine contractions
Passenger- size, presentation and position of foetus
Passage- cephalopelvic disproportion

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71
Q

what proportion of women will develop breast cancer in their lifetime?

A

1 in 8

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72
Q

what are the risk factors for breast cancer?

A

Female (99% of breast cancers)
Increased oestrogen exposure (earlier onset of periods and later menopause)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
Family history (first-degree relatives)

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73
Q

what effect does the COCP have on breast cancer risk?

A

small increase in risk, returns to normal 10 years after stopping the pill

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74
Q

what affect does HRT use have on the risk of breast cancer?

A

increases the risk, particularly combined HRT

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75
Q

where is the BRCA1 gene found?

A

Chromosome 17

76
Q

what risks are conferred by BRCA1?

A

Around 70% will develop breast cancer by aged 80
Around 50% will develop ovarian cancer
Also increased risk of bowel and prostate cancer

77
Q

what risk is conferred by BRCA2?

A

Around 60% will develop breast cancer by aged 80
Around 20% will develop ovarian cancer

78
Q

where is BRCA2 found?

A

chromosome 13

79
Q

Other than BRCA, what other genes are associated with breast cancer?

A

TP53 and PTEN genes

80
Q

what is Ductal Carcinoma In Situ?

A

Pre-cancerous or cancerous epithelial cells of the breast ducts
Localised to a single area

81
Q

What is the prognosis of DCIS?

A

Potential to spread locally over years
Potential to become an invasive breast cancer (around 30%)
Good prognosis if full excised and adjuvant treatment is used

82
Q

What is Lobular Carcinoma in Situ?

A

A pre-cancerous condition occurring typically in pre-menopausal women

83
Q

How is LCIS usually detected?

A

Usually asymptomatic and undetectable on a mammogram
Usually diagnosed incidentally on a breast biopsy

84
Q

How is LCIS usually managed?

A

Often managed with close monitoring (e.g., 6 monthly examination and yearly mammograms)

85
Q

what is the prognosis of LCIS?

A

Represents an increased risk of invasive breast cancer in the future (around 30%)

86
Q

what cells do Invasive Ductal Carcinoma originate from?

A

cells of the breast ducts

87
Q

what % of breast cancers are invasive ductal carcinoma?

A

80%

88
Q

can Invasive Ductal Carcinomas be seen on mammograms?

A

yes

89
Q

What % of invasive breast cancers are Invasive Lobular Carcinomas?

A

10%

90
Q

what cells do Invasive Lobular Carcinomas originate from?

A

cells from the breast lobules

91
Q

are Invasive Lobular Carcinomas visible on mammograms?

A

not always

92
Q

which breast cancer presents similarly to a breast abscess or mastitis?

A

Inflammatory Breast Cancer

93
Q

What % of breast cancers are Inflammatory Breast Cancer?

A

1-3%

94
Q

How does inflammatory breast cancer present?

A

Swollen, warm, tender breast with pitting skin (peau d’orange)
Similar to abscess or mastitis but won’t respond to ABx

95
Q

what is the prognosis for inflammatory breast cancer?

A

worse than other breast cancers

96
Q

what is Paget’s disease of the nipple?

A

Looks like eczema of the nipple/areolar
Erythematous, scaly rash

97
Q

What does Paget’s disease of the nipple suggest?

A

Indicates breast cancer involving the nipple
May represent DCIS or invasive breast cancer

98
Q

what management is requires for Paget’s disease of the nipple?

A

Requires biopsy, staging and treatment, as with any other invasive breast cancer

99
Q

What are the rarer types of breast cancer?

A

Medullary breast cancer
Mucinous breast cancer
Tubular breast cancer
Multiple others

100
Q

who is offered a mammogram under NHS breast cancer screening?

A

women aged 50-70, every 3 years

101
Q

what proportion of women going for a screening mammogram will be diagnosed with breast cancer?

A

1 in 100

102
Q

what are the potential downsides to breast cancer screening?

A

Anxiety and stress
Exposure to radiation, with a very small risk of causing breast cancer
Missing cancer, leading to false reassurance
Unnecessary further tests or treatment where findings would not have otherwise caused harm

103
Q

what are the criteria for referral from primary care for high risk breast cancer?

A

A first-degree relative with breast cancer under 40 years
A first-degree male relative with breast cancer
A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
Two first-degree relatives with breast cancer

104
Q

What might be offered to women with high risk for breast cancer?

A

genetic counselling
annual mammogram
chemoprevention
risk-reducing bilateral mastectomy

105
Q

what drugs can be offered for chemoprevention of breast cancer?

A

Tamoxifen if premenopausal
Anastrozole if postmenopausal (except with severe osteoporosis)

106
Q

what clinical features can suggest breast cancer?

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
Lymphadenopathy, particularly in the axilla

107
Q

What is the NICE criteria for a 2 week wait referral for breast cancer?

A

An unexplained breast lump in patients aged 30 or above
Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

108
Q

When does nice recommend CONSIDERING a 2 week wait referral for breast cancer?

A

An unexplained lump in the axilla in patients aged 30 or above
Skin changes suggestive of breast cancer

109
Q

When would NICE recommend a non-urgent breast referral?

A

unexplained breast lumps in a patient under 30 years.

110
Q

What should patients referred under 2 week wait receive initially?

A

triple diagnostic assessment:
Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Biopsy (fine needle aspiration or core biopsy)

111
Q

Who are breast ultrasounds most useful in?

A

women under 30 years- they can help distinguish solid lumps from cystic lumps

112
Q

Who are mammograms most useful in?

A

older women- they can pick up calcifications missed by ultrasound

113
Q

who may breast MRI scans be used?

A

For screening in women at higher risk of developing breast cancer (e.g., strong family history)
To further assess the size and features of a tumour

114
Q

How are the lymph nodes examined in breast cancer?

A

All women are offered an ultrasound of the axilla (armpit) and ultrasound-guided biopsy of any abnormal nodes.
A sentinel lymph node biopsy may be used during breast cancer surgery where the initial ultrasound does not show any abnormal nodes.

115
Q

What receptors are present on breast cells that can be targeted in treatment?

A

Oestrogen receptors (ER)
Progesterone receptors (PR)
Human epidermal growth factor (HER2)

116
Q

What is triple negative breast cancer and what is it’s prognosis?

A

the breast cancer doesn’t carry any of the three target receptors
it has a worse prognosis

117
Q

What is gene expression profiling?

A

assessing which genes are present within the breast cancer on a histology sample, to predict the probability that it will reoccur as a distal metastasis in 10 years

118
Q

Who does NICE recommend gene expression profiling for?

A

women with early breast cancers that are ER positive but HER2 and lymph node negative. It helps guide whether to give additional chemotherapy.

119
Q

which 4 locations does breast cancer often metastasise to?

A

Lungs
Liver
Bones
Brain

120
Q

after triple assessment, what additional investigations may be required for breast cancer?

A

Lymph node assessment and biopsy
MRI of the breast and axilla
Liver ultrasound for liver metastasis
CT of the thorax, abdomen and pelvis for lung, abdominal or pelvic metastasis
Isotope bone scan for bony metastasis

121
Q

What system is used to grade breast cancer?

A

TNM system (Tumour, Nodes, Metastasis)

122
Q

What are the surgical options for breast tumour removal?

A

Breast-conserving surgery (e.g., wide local excision), usually coupled with radiotherapy
Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction

123
Q

What is the risk of axillary clearance?

A

increased risk of lymphoedema

124
Q

what are the non-surgical management options of lymphoedema?

A

Massage techniques to manually drain the lymphatic system (manual lymphatic drainage)
Compression bandages
Specific lymphoedema exercises to improve lymph drainage
Weight loss if overweight
Good skin care

125
Q

What are common side effects from radiotherapy?

A

General fatigue from the radiation
Local skin and tissue irritation and swelling
Fibrosis of breast tissue
Shrinking of breast tissue
Long term skin colour changes (usually darker)

126
Q

when is chemotherapy used in breast cancer?

A

Neoadjuvant therapy – intended to shrink the tumour before surgery
Adjuvant chemotherapy – given after surgery to reduce recurrence
Treatment of metastatic or recurrent breast cancer

127
Q

Who may be given hormone treatment for breast cancer?

A

Patients with oestrogen-receptor positive breast cancer

128
Q

What are the two main first line options for hormone treatment of breast cancer?

A

Tamoxifen for premenopausal women
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)

129
Q

How does Tamoxifen work?

A

Tamoxifen is a selective oestrogen receptor modulator (SERM). It either blocks or stimulates oestrogen receptors, depending on the site of action.

130
Q

Where does tamoxifen block oestrogen?

A

breast tissue

131
Q
A
132
Q

what are the positive and negative side effects of tamoxifen?

A

it helps prevent osteoporosis, but it does increase the risk of endometrial cancer.

133
Q

Where is aromatase found and what is its role?

A

fat tissue, it converts androgens to oestrogen

134
Q

what is the primary source of oestrogen after menopause>

A

aromatase in fat tissue

135
Q

how long after breast cancer are hormone treatments given?

A

5-10 years

136
Q

other than tamoxifen and aromatase inhibitors, what options are available to women with oestrogen receptor positive breast cancer?

A

Fulvestrant (selective oestrogen receptor downregulator)
GnRH agonists (e.g., goserelin or leuprorelin)
Ovarian surgery

137
Q

How does herceptin work?

A

Trastuzumab (Herceptin) is a monoclonal antibody that targets the HER2 receptor.

138
Q

what is a negative side effect of Herceptin?

A

it can affect heart function so initial and close monitoring of heart function is required.

139
Q

what treatments are available for HER2 positive breast cancer?

A

Trastazumab (Herceptin), Pertuzumab (Perjeta) and Neratinib (Nerlynx)

140
Q

What is bacterial vaginosis?

A

An overgrowth of anaerobic bacteria and the loss of lactobacilli in the vagina.

141
Q

What is the change in pH in bacterial vaginosis?

A

Becomes more alkaline due to reduced number of acid producing lactobacilli.

142
Q

Which bacteria are associated with bacterial vaginosis?

A

Anaerobic bacteria, particularly:
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species

143
Q

what are the factors that increase the risk of developing bacterial vaginosis?

A

Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil

144
Q

how does bacterial vaginosis present?

A

fishy-smelling watery grey or white discharge
usually not itchy/ irritated/ painful
half are asymptomatic

145
Q

what investigations can be done in bacterial vaginosis?

A

a speculum examination to confirm the discharge
a high vaginal swab/ self-taken low vaginal swab
testing bacterial pH

146
Q

What infection would ‘clue cells’ indicate?

A

bacterial vaginosis
they are epithelial cells from the cervix with bacteria stuck inside them- usually Gardnerella vaginalis

147
Q

does asymptomatic BV require treatment?

A

not usually

148
Q

what antibiotics are indicated in BV?

A

Metronidazole orally or by vaginal gel
Alternatively, Clindamycin

149
Q

what should patients starting Metronidazole be advised?

A

Avoid alcohol for the duration
Alcohol and metronidazole can cause a ‘disulfiram-like reaction’, with nausea and vomiting, flushing and sometimes shock and angioedema.

150
Q

what are the possible complications of BV?

A

increased risk of STIs such as chlamydia, gonorrhoea and HIV

151
Q

What are the complications of BV in pregnant women?

A

Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis

152
Q

what is the most common causative organism of thrush?

A

Candida albicans

153
Q

Is Candida in the vagina always pathogenic?

A

no, it can colonise harmlessly and progress to infection opportunistically e.g. after ABx, in pregnancy

154
Q

What are the risk factors for thrush?

A

Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics

155
Q

What are the typical symptoms of thrush?

A

Thick, white discharge that does not typically smell
Vulval and vaginal itching, irritation or discomfort

156
Q

what can severe thrush lead to?

A

Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation

157
Q

what can confirm a diagnosis of thrush?

A

A charcoal swab with microscopy

158
Q

what type of organism is trichomonas?

A

A protozoan- single celled organism with flagella

159
Q

Where does trichomonas live?

A

the urethra of men and women and vagina of women

160
Q

what can trichomonas increase the risk of?

A

Contracting HIV by damaging the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complications such as preterm delivery.

161
Q

What are the typical symptoms of trichomoniasis?

A

Vaginal discharge
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)

50% of cases are asymptomatic

162
Q

How is the discharge in trichomoniasis typically described?

A

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

163
Q

What would a ‘strawberry cervix’ suggest?

A

characteristic of trichomoniasis
caused by inflammation and tiny haemorrhages on the cervix

164
Q

what would the vaginal pH be in trichomoniasis?

A

it will be raised (above 4.5)

165
Q

how would a diagnosis of trichomoniasis be confirmed in women?

A

a charcoal swab from the posterior fornix of the vagina/ low vaginal swab and microscopy

166
Q

How would trichomoniasis be diagnosed in men?

A

A urethral swab or first-catch urine for microscopy.

167
Q

what is the treatment for trichomoniasis?

A

metronidazole

168
Q

what is the most common STI in the UK?

A

Chlamydia

169
Q

what type of organism is chlamydia?

A

Chlamydia trachomatis is a gram-negative bacteria.

170
Q

Can asymptomatic patients still pass on chlamydia?

A

yes

171
Q

What does the National Chlamydia Screening Programme aim to do?

A

Screen every sexually active person under 25 for chlamydia annually or when they change their partner, and retest 3 months after treatment.

172
Q

what are people generally screened for when they get an STI screening?

A

Chlamydia
Gonorrhoea
Syphilis (blood test)
HIV (blood test)

173
Q

What infections can charcoal swabs confirm?

A

Bacterial vaginosis
Candidiasis
Gonorrhoeae (specifically endocervical swab)
Trichomonas vaginalis (specifically a swab from the posterior fornix)
Other bacteria, such as group B streptococcus (GBS)

174
Q

How do Nucleic Acid Amplification Tests work?

A

they test directly for DNA or RNA of the organism

175
Q

what organisms can NAAT test for?

A

chlamydia and gonorrhoea

176
Q

what symptoms could suggest chlamydia in women?

A

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)

177
Q

what symptoms could suggest chlamydia in men?

A

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

178
Q

what examination findings might be present in chlamydia?

A

Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

179
Q

what is first line for uncomplicated chlamydia?

A

doxycycline 100mg twice a day for 7 days

180
Q

what are some antibiotic options for chlamydia in pregnancy?

A

azithromycin, erythromycin and amoxicillin

181
Q

what are some possible complications from chlamydia?

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

182
Q

what are some complications of chlamydia in pregnancy?

A

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

183
Q

what is lymphogranuloma venereum?

A

a condition affecting the lymphoid gland around the site of infection in chlamydia, mainly occurring in MSM

184
Q

what is the first line treatment of lymphogranuloma venerum?

A

Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV recommended by BASHH. Erythromycin, azithromycin and ofloxacin are alternatives.

185
Q

what is the primary stage of lymphogranuloma venereum?

A

The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex.

186
Q

what is the secondary stage of lymphogranuloma venereum?

A

The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected.

187
Q

what is the primary stage of lymphogranuloma venereum?

A

The tertiary stage involves inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion.

188
Q

how does chlamydial conjunctivitis present?

A

chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.

189
Q

what is a differential diagnosis for chlamydial conjunctivitis?

A

phase 3a medicine (4 decks)

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