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Obstetrics and Gynaecology > Y4 Sexual Health > Flashcards

Y4 Sexual Health Flashcards

1
Q

When does jaundice in a neonate need to be investigated?

A

<24hrs
>14days

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2
Q

Causes of jaundice in the first 24 hrs:

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

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3
Q

Causes of prolonged jaundice (14 days after birth)

A

biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
- jaundice is more common in breastfed babies
- mechanism is not fully understood but thought to be due to high concentrations of beta-glucuronidase → increase in intestinal absorption of unconjugated bilirubin
prematurity
- due to immature liver function
- increased risk of kernicterus
congenital infections e.g. CMV, toxoplasmosis

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4
Q

Migraine prevention medication in women of child bearing age?

A

Propanolol

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5
Q

What is meant by the term adenomyosis?

A

If endometrial tissue is present in uterine muscle, the termadenomyosisis used.

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6
Q

Symptoms of endometriosis:

A

Cyclic pelvic pain!

Dysmenorrhoea, dyspareunia, dysuria, dyschezia (difficult, painful defecating), and subfertility.

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7
Q

Findings from a bimanual exam in endometriosis:

A
  • A fixed, retroverted uterus
  • Uterosacral ligament nodules
  • General tenderness
    • Note: An enlarged, tender and boggy uterus is indicative of adenomyosis.
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8
Q

Endometriosis differentials for the OSCE:

A

Pelvic inflammatory disease
Ectopic pregnancy
Fibroids
IBS

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9
Q

Investigations for endometriosis:

A

Gold standard laprascopy
Ultrasound

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10
Q

Summarise the management of endometriosis:

A
  1. Analgesia - NSAID’s / analgesic ladder.
  2. Suppress ovulation - Low-doseCOCP, injectable or mirena.
  3. Surgery - laser ablation to remove ectopic endometrial tissue. Relapses will occur so hysterectomy is definitive.
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11
Q

Describe endometriosis for an OSCE:

A

Endometriosis is a chronic condition where endometrial tissue is present at other sites other than the uterine cavity such as ovaries, pouch of Douglas, uterosacral ligaments, pelvic peritoneum, bladder umbilicus and lungs.
Patients may be asymptomatic. Signs and symptoms also include pelvic pain, dysmenorrhoea, dyspareunia and subfertility.

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12
Q

Risk factors for pelvic inflammatory disease:

A
  • Sexually active
  • Aged under 15-24
  • Recent partner change
  • Intercourse without barrier contraceptive protection
  • History of STIs
  • Personal history of pelvic inflammatory disease

Pelvic inflammatory disease can also occur via instrumentationof the cervix – inadvertently introducing bacteria into the female reproductive tract. Such procedures include gynaecological surgery, termination of pregnancy, and insertion of an intrauterine contraceptive device.

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13
Q

Features of pelvic inflammatory disease:

A
  • Lower abdominal pain
  • Deep dyspareunia (painful sexual intercourse)
  • Menstrual abnormalities (e.g menorrhagia, dysmenorrhoea or intermenstrual bleeding)
  • Post-coital bleeding
  • Dysuria (painful urination)
  • Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)

In advanced cases, women can experience severe lower abdominal pain,fever (>38° C), and nausea and vomiting.

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14
Q

What is seen on vaginal examination in pelvic inflammatory disease?

A

On vaginal examination, there may be tenderness of uterus/adnexae or cervical excitation (on bimanual palpation). There may be a palpable mass in the lower abdomen, with an abnormal vaginal discharge noted.

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15
Q

Explain what pelvic inflammatory is for an OSCE:

A

Pelvic inflammatory disease refers to an infective inflammation of the endometrium, uterus, fallopian tubes (salpingitis), ovaries and peritoneum. It is caused by the spread of bacterial infection from the vagina or cervix to the upper genital tract.

Chlamydia trachomatis and Neisseria gonorrhoeaare responsible for approximately 25% of cases.

Features include: Umbilical pain, dyspareunia, post-coital bleeding, dysuria, vaginal discharge with odour. Fever is a late sign.

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16
Q

Differentials of PID for the OSCE:

A
  • Ectopic pregnancy (a pregnancy test is mandatory to exclude this).
  • Ruptured ovarian cyst
  • Endometriosis
  • Urinary tract infection
    -STI
17
Q

Investigations for pelvic inflammatory disease:

A
  1. Vaginal swabs to identify the organism.
  2. Full STI screen (HIV, syphilis, gonorrhoea and chlamydia as a minimum).
  3. Urine dipstick and culture to exclude UTI.
  4. Pregnancy test.
  5. Transvaginal ultrasound
  6. Laprascopy - observe inflammatory changes and peritoneal biopsy.
18
Q

What are the different types of vaginal swab and what do they respectively test for?

A
  1. Endocervical swabs - gonorrhoea and chlamydia.
  2. High vaginal swab - trichomonas vaginalis and bacterial vaginosis.
19
Q

How is pelvic inflammatory disease managed?

A
  1. Antibiotics (Doxycycline, ceftriaxone and metronidazole) - treats all 3 common causes (clap, gon, trich)
  2. Analgesics - paracetamol
  3. Abstain from sex
  4. Test any sexual partners in the last 6 months.
  5. Consider hospital admission
20
Q

Talk through the use of antibiotics to treat PID:
- what’s used?
- when are they started?

A

Treatment is a14-day course of broad spectrum antibiotics with good anaerobic coverage. This should be commenced immediately, before the results of swabs are available. Options include:

  • Doxycycline, ceftriaxone and metronidazole
  • Ofloxacin and metronidazole
21
Q

When should a patient with pelvic inflammatory disease be admitted to hospital?

A
  • If pregnant and especially if there is a risk of ectopic pregnancy.
  • Severe symptoms: nausea, vomiting, high fever.
  • Signs of pelvic peritonitis.
  • Unresponsive to oral antibiotics, need for IV therapy.
  • Need for emergency surgery or suspicion of alternative diagnosis.
22
Q

When should a patient with pelvic inflammatory disease be admitted to hospital?

A
  • If pregnant and especially if there is a risk of ectopic pregnancy.
  • Severe symptoms: nausea, vomiting, high fever.
  • Signs of pelvic peritonitis.
  • Unresponsive to oral antibiotics, need for IV therapy.
  • Need for emergency surgery or suspicion of alternative diagnosis.
23
Q

Complications of pelvic inflammatory disease:

A
  • Ectopic pregnancy– due to narrowing and scarring of the fallopian tubes
  • Infertility– affects 1 in 10 women with PID.
  • Tubo-ovarian abscess
  • Chronic pelvic pain
  • Fitz-Hugh Curtis syndrome– perihepatitis that typically causes right upper quadrant pain
24
Q

Describe bacterial vaginosis for an OSCE:

A

Bacterial vaginosis (BV) describes an overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid-producing aerobic lactobacilli resulting in a raised vaginal pH.

Whilst BV is not a sexually transmitted infection it is seen almost exclusively in sexually active women.

  • Vaginal discharge: ‘fishy’, offensive
  • Asymptomatic in 50%
25
Q

How is BV diagnosed?

A

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour).
26
Q

BV treatment:

A

Oral metronidazole for 5-7 days

Topical metronidazole ortopical clindamycinare alternatives.

27
Q

Frothy green/yellow offensive discharge, strawberry cervix and vulvovagnitis.

  • Diagnosis and treatment:
A

Trichomonas - treat with oral metronidazole.

28
Q

What is the pathogen in 90% of candidiasis cases?

A

Candida albicans

29
Q

Risk factors for candidiasis:

A

Pregnancy
Diabetes
Immunosuppression: HIV, use of corticosteroids, cancer.
Recent broad spec antibiotics

30
Q

Symptoms of candidiasis:

A

Itchy vulva
White thin excessive discharge
Dysuria

31
Q

Signs on examination in candidiasis:

A
  • Erythema and swelling of the vulva
  • Satellite lesions
    • Red, pustular lesions with superficial white/creamy pseudomembranous plaques that can be scraped off.
  • Curd-like discharge in vagina.
32
Q

OSCE differentials for candidiasis:

A

BV
Trichomonas
UTI

Non-infective conditions:
Contact dermatitis
Eczema / Psoriasis

Screen for diabetes as an underlying disorder.

33
Q

Investigations for candidiasis:

A
  1. In simple cases can be a clinical diagnosis, recommended to measure vaginal pH.
  2. Complicated / Recurrent: Vaginal smear (presence of spores and mycelia are diagnostic of candida infection - but may be present in women with commensal candida albicans).
34
Q

Treatment of candidiasis:

A

ORAL FLUCONAZOLE 1st line

  1. Intravaginal antifungal - clotrimazol.
  2. Oral antifungal e.g fluconazole is an alternative.
  3. Topical imidazolecan also be prescribed in conjunction with the oral or intravaginal antifungal to address vulval symptoms.
  4. Manage diabetes, check medication is being administered correctly.
35
Q

Management of candidiasis in pregnancy:

A
  • Treat infection with intravaginal antifungal (e.g. clotrimazole)
  • Do not give oral antifungals such as fluconazole and itraconazole.
36
Q

BV is overgrowth of what…?

A

Gardnerella vaginalis

37
Q

Investigation of choice for genital herpes:

A

Nucleic acid amplification tests (NAAT)

38
Q

What type of swab for gonnorrhea?

A

Vulvovaginal

Obstetrics and Gynaecology (11 decks)

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