Genito-urinary medicine Flashcards

Question

Tubal ligation - what happens - failure rate - associated with what?

Answer 1

Tying.blocking/partial exclusion of fallopian tubes Failure rate 0.75-3.5% Associated with ectopic pregnancies

Answer 2

Failure rate 3-6% | Prevents STIs

Answer 3

``` Under 25 New sexual partner lack of barrier contraception Women undergoing TOP COCP ```

Answer 4

High vaginal (sweep the posterior fornix - candida, trichomonas, BV) Endocervical (1cm into endocervix, rotate gently - gonorrhoea) Endocervix (1cm into endocervix, rotate vigorously for 10s - chlamydia)

Answer 5

Intracellular bacterium, affects endocervix and urethra Sx: discharge, lower abdo pain, irregular PV bleed, dyspareunia, urinary symptoms Exam: normal, +/- discharge, cervicitis, contact bleeding, adnexal tenderness Diagnosis: endocervical swab, NAAT Mx: 1g oral azithromycin stat, or 100mg oral doxycycline BD 7 days (CI in pregnancy), or 500mg erythromycin QDS 7 days or BD 14 days Complications: PID, ectopics, chronic pelvic pain, infertility

Answer 6

Prem delivery, foetal growth restriction, low birth weight, increased neonatal morbidity/mortality, still birth, miscarriage, neonatal conjunctivitis, neonatal pneumonia

Answer 7

Gram neg diplococci, affects mucous membranes of endocervix, urethra, rectum, eye and throat Sx: discharge, lower abdo pain, IMB/PCB, dysuria, dyspareunia Exam: discharge, cervicitis, contact bleeding, pelvic tenderness Diagnosis: NAAT, culture from endocervical/ urethral/ rectal/ throat swabs Mx: IM ceftriaxone 1g stat Complications: PID, chronic pain, infertility, ectopics, disseminated gonococcal infection, gonococcal septic arthritis

Answer 8

Offered to all patients aged 15-24

Answer 9

Protozoa infection the vagina, urethra and paraurethral glands Features: vaginal discharge (offensive yellow/green frothy), vulvovaginitis, strawberry cervix, pH >4.5, dysuria, dyspareunia Diagnosis: high vaginal swab culture, direct observation of flagellates on a wet smear microscopy Mx: metronidazole 2g oral stat, or metronidazole 400mg BD 5 days Trichomonas in pregnancy: metronidazole not recommended in early pregnancy, and high dose metronidazole not recommended at all. If necessary, give a 5 day course in tri 1 Complications: PROM, low birth weight, maternal postpartum sepsis

Answer 10

Perinatal mortality, spontaneous abortion, prem labour, early foetal membrane rupture Neonatal conjunctivitis

Answer 11

HSV type 1 or type 2. virus stays latent after primary infection and then may reactivate, causing infectious viral shedding Symptoms: multiple painful small blisters around labia, dysuria, and vaginal discharge Primary attack most severe: malaise, fever, anorexia, lymphadenopathy Secondary attack: may occur during stress, less severe, may go unnoticed Diagnosis: viral swab from base of lesion (rub to deroof lesion - painful) Management: aciclovir 200mg 5 times a day for 5 days Complications: urinary retention, aseptic meningitis, encephalitis C-section at term if primary attack occurs during pregnancy after 28 weeks

Answer 12

HPV 6 and 11. Painless unsightly lesions on vagina, cervix, urethral meatus and anus Examination: single or multiple irregular lesions (+/- bleeding, itching) Diagnosis usually clinical (biopsy if pigmented) Management: First line is topical podophyllum or cryotherapy Excision under LA/GA Electrocautery or laser treatment

Answer 13

Treponema pallidum (spirochaete bacterium) Primary: single painless indurated exudative genital ulcer (chancre) with regional lymphadenopathy Secondary: 6-10wks later, malaise, fever, arthralgia, polymorphic rash, condylomata lata (wart plaques in moist areas), generalised lymphadenopathy Tertiary: chronic granulomatous lesions of skin/bones, tabes dorsalis (charcot joint), argyll-robertson pupil, ascending aortic aneurysms, general paralysis

Answer 14

70-100% of babies form infected mothers will have congenital syphilis, with 30% resulting in still births, so treatment should be started ASAP Congenital syphilis: <2yrs. Condylomata lata, saddle nose, deafness, keratitis

Answer 15

All women offered hep B screening Babies born to infected women get hep B vaccines and hep B immunoglobulin Not transmitted via breast feeding

Answer 16

Reduces vertical transmission fro 30% to 2%: - Maternal antiretroviral therapy during pregnancy - Caesarean section if notable viral load - Neonatal antiretroviral therapy - Bottle feeding (avoid breast feeding) HIV screening in all pregnancy women

Answer 17

Overgrowth of anaerobic Gardnerella vaginalis causes eradication of normal lactobacilli and increase in vaginal pH to up to 7 (normally <4.5) Risk factors: smoking, IUD, black women, lots of sex Features: asymptomatic, or offensive fishy smell, profuse thin white/creamy discharge Diagnosis: Amsell's criteria (3 of the 4 must be found): thin creamy discharge, clue cells at microscopy, sniff test (fishy when adding KOH), vaginal fluid pH>4.5 Management: oral metronidazole 400mg BD for 5 days, or 2g metronidazole stat avoid vaginal douching, bath additives and soap

Answer 18

``` Amsells criteria 3 out of 4 must be present for diagnosis 1. thin creamy discharge 2. clue cells at microscopy 3. sniff test (fishy odour when adding KOH) 4. vaginal fluid pH >4.5 ```

Answer 19

Associated with increased mid-trimester loss, preterm prelabour ROM, preterm delivery and postnatal endometriosis

Answer 20

Candida albicans fungus Risk factors: DM, drugs (abx, steroids), pregnancy, immunosuppression (HIV, iatrogenic) Features: asymptomatic, or itching, vulvitis, white lumpy cottage cheese discharge which doesnt smell, dysuria, superficial dyspareunia, vulval excoriation and inflammation, vaginal erythema Diagnosis: microscopy showing spore and pseudohyphae Mx: only indicated in symptomatic cases Cotrimazole pessary, or oral itraconazole/fluconazole Avoid tight fitted clothes, wear cotton, avoid irritants, live yoghurt

Genito-urinary medicine Flashcards

(44 cards)