GUM Flashcards

Question

Management of gonorrhoea?

Answer 1

Uncomplicated: IM ceftriaxone 1g if sensitivities unknown, if sensitivities known + sensitive to ciprofloxacin 500mg. If ceftriaxone refused: oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose). Complicated: ceftriaxone + doxycycline Disseminated: add azithromycin

Answer 2

- tenosynovitis - migratory polyarthritis - dermatitis (lesions can be maculopapular or vesicular)

Answer 3

caused by the many varieties of the human papillomavirus HPV, especially types 6 & 11. Features - small (2 - 5 mm) fleshy protuberances which are slightly pigmented - may bleed or itch Management - topical podophyllum or cryotherapy are commonly used as first-line treatments depending on the location and type of lesion > multiple, non-keratinised warts are generally best treated with topical agents > solitary, keratinised warts respond better to cryotherapy - imiquimod is a topical cream that is generally used second line - genital warts are often resistant to treatment and recurrence is common although the majority of anogenital infections with HPV clear without intervention within 1-2 years - surgical removal

Answer 4

Unicellular eukaryote, most common opportunistic infection in AIDs. All pts CD4 <200/mm3 Sx: Dyspnoea, dry cough Fever Very few chest signs ``` Complications: Pneumothorax Hepatosplenomegaly Lymphadenopathy Choroid lesions ``` Investigations: CXR: bilat interstitial pul infiltrates Exercise induced desat Sputum often fails to show PCP, bronchoalveolar lavage often needed Management: All pts CD4 <200/mm3 should receive PCP prophylaxis. Cotrimoxazole IV pentamidine Aerosolised pentamidine. Less effective with risk of pneumothorax Steroids if hypoxic

Answer 5

``` Toxoplasmosis 50% of cerebral lesions in pts with HIV Headache, confusion, drowsiness CT: single/ multiple ring enhancing lesions, mass effect, thallium SPECT neg Tx: sulfadiazine, pyrimethamine ``` 1° CNS lymphomas 30% cerebral lesions. EBV associated CT: single or multiple homogenous (solid) enhancing lesions, SPECT post. Tx: steroids, chemo (methotrexate), irradiation, surgery. Tuberculosis: less common, single enhancing lesion. Encephalitis: CMV or HIV itself. CT: oedema brain. AIDS dementia complex: HIV itself Behav changes. Motor impairment. CT: cortical + subcortical atrophy Cryptococcus Most common fungal infection of CNS. Headache, fever, malaise, N/V, seizures focal neurological deficit. CSF: high opening pressure, india ink pos. CT: meningeal enhancement, cerebral oedema. May cause SOL. Progressive multifocal leukoencephalopathy Widespread demyelination. Due to infection of oligodendrocytes by JC virus (a polyoma DNA virus) Subacute onset, behav changes, speech, motor, visual impairment CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI: better, high signal demyelination, white matter lesion seen

Answer 6

AIDS: 10-15yrs 3 stages: acute infection, clinical latency, AIDS Virus attaches to CD4 receptor on host cell (t lymphocytes, macrophages, monocyte, dendritic cells), with gp120

Answer 7

``` 2-6wks after infection Sore throat, ulceration, painful swallowing Lymphadenopathy Malaise, myalgia, arthralgia D/N, WL Maculopapular rash Mouth ulcers Rarely meningoencephalitis ``` Diarrhoea: HIV enteritis or opportunistic cases. Cryptosporidium + other protoxoa, CMV, mycobacterium avum, intracellular, giardia. Cryptosporidium: most common, intracellular protozoa, 7 day incubation. Mild-severe diarrhoea. Modified Ziehl-Neelsen stain of stool may reveal red cysts. Tx difficult, mainly supportive. Mycobacterium avium intracellulare: atypical mycobacteria in CD4 <50. Features: fever, sweats, abdo pain, diarrhoea. Hepatomegaly, deranged LFTs. Blood cultures + BM exam. Tx: rifabutin, ethambutol + clarithromycin.

Answer 8

Pregnancy: vaginal delivery if viral load <50 copies/ml at 36 wks. Zidovudine infusion started 4hrs before CS. Zidovudine administered orally to neonate if maternal load <50copies.ml, otherwise triple ART used, therapy for 4-6wks. Advised not to BF Kaposi’s sarcoma: HHV-8, purple papules or plaques on skin or mucosa (GIT, RT), tumour of vascular + endothelium, skin lesions may ulcerate. Resp involvement may cause massive haemoptysis + pleural effusion. Radiotherapy + resection. Oesophageal candidiasis: CD4<100 dysphagia, odynophagia. Tx: fluconazole, itraconazole

Answer 9

HIV antibodies: ELISA + Western blot assay P24 antigen: viral core protein, early in blood as RNA levels↑. Combination HIV p24 + HIV IG: if pos repeat to confirm. If asymptomatic 4wks after poss exposure repeat at 12 wks if initial neg. Post Tx: viral RNA load, CD4+ count, CD4+:CD8 ratio. Start ART as soon as diagnosed

Answer 10

Pre-exposure prophylaxis PrEP, if sig risk for HIV, daily dose, prevent infection, useful in IVDU Post-exposure prophylaxis: PEP, HIV neg who have been exposed. Tenofovir, emtricitabine, lopinavir + ritonavir ASAP up t0 72hrs following exposure. For 4wks 2 NRTI + PI or NNRTI or INI or 3NRTI NRTI: zidovudine, lamivudine, abacavir. Emtricitabine, didanosine, stravudine, zalcitabine, tenofovir. NNRTI: nevirapine, efavirenz, delavirdine. Protease inhibs: indinavir, nelfinavir, ritonavir, saquinavir. Integrase inhibs: block action of integrase. Raltegravir, elvitegravir, dolutegravir. SE: ↑CK Entry inhibs: enfuvirtide, maraviroc.

Answer 11

HSV-2 but there is overlap Initial infection > latent in sensory nerve ganglia (trigeminal cold sores, sacral in genital).

Answer 12

Asymptomatic 2 wks after infection Ulcers or blistering lesions, vesicular, painful, genital ulceration. Aphthous ulcers, small painful. Mouth Neuropathic pain: tingling, burning, shooting. Flu like Sx: fatigue, headache Dysuria, urinary retention (pain + autonomic neuropathy)

Answer 13

Herpes keratitis: inflam of cornea, dendritic corneal ulcer, painful red eye, photophobia, epiphora, visual acuity ↓. Immediate opthalmology referral topical acyclovir. Herpetic whitlow: painful skin lesion on finger + thumb Pregnancy: risk of neonatal herpes simplex during labour

Answer 14

NAAT HSV serology

Answer 15

GUM referral Acyclovir Chlorhexidine mouth wash Tx of Sx: paracetamol, topical lidocaine (2% gel), clean with warm salt water, topical Vaseline, oral fluids, wear loose clothing, avoid intercourse Pregnancy 1° <28wks: acyclovir from 36 wks, if asymptomatic at delivery can do vaginal, CS preferred 1° >28wks: acyclovir immediately, elective c-section at term preferred Recurrent: regular prophylactic acyclovir from 36 wks gestation

Answer 16

a sexually transmitted infection caused by the spirochaete Treponema pallidum. Infection is characterised by primary, secondary and tertiary stages. The incubation period is between 9-90 days Transmission: oral, vaginal anal sex, mother to baby, IVDU, blood transfusion, transplants. Latent: asymptomatic, 2yrs + onwards

Answer 17

Primary features - chancre - painless ulcer at the site of sexual contact - local non-tender lymphadenopathy - often not seen in women (the lesion may be on the cervix) Secondary features - occurs 6-10 weeks after primary infection - systemic symptoms: fevers, lymphadenopathy - rash on trunk, palms and soles - buccal 'snail track' ulcers (30%) - condylomata lata (painless, warty lesions on the genitalia ) ``` Tertiary features gummas (granulomatous lesions of the skin and bones) ascending aortic aneurysms general paralysis of the insane tabes dorsalis Argyll-Robertson pupil ``` Features of congenital syphilis blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars rhagades (linear scars at the angle of the mouth) keratitis saber shins saddle nose deafness

Answer 18

Tabes dorsalis > ataxia Neurosyphilis: headache, altered behav, dementia, paralysis, sensory impairment, Argyll Robertson pupil (constricted pupil, accommodates when focusing on near object but doesn’t react to light), altered mood, confusion. Pregnancy: IUGR, spont abortion, stillbirth, premature labour.

Answer 19

Single deep IM benzathine benpen. Alternatives > doxycycline. Late + neurosyphilis: ceftriaxone, amoxicillin, doxycycline. Congen: IV aqueous benpen or IM procaine benpen Jarisch-Herxheimer reaction: following Tx, fever, rash, ↑HR, after 1st dose of Abx, no wheeze of hypotension. Release of endotoxins following bacterial death. Typically within few hrs of Tx. No tx other than antipyretics. Cardiolipin false pos pregnancy, SLE, APS TB, leprosy, HIV, malaria.

Answer 20

Non-gonococcal urethritis Bacteria. Can also be caused by chlamydia trachomatis

Answer 21

Similar to chlamydia Urethritis Dysuria Pain on ejaculation Watery/cloudy discharge (onset of Sx between 4 days + wks after contact) Proctitis Bleeding between periods Lower abdo pain Dyspareunia Urethral irritation or itching between voids Orchialgia (heaviness in male genitals)

Answer 22

Epididymitis Orchitis Cervicitis Endometriosis PID Reactive arthritis Preterm delivery Tubal infertility

Answer 23

Slow growing swabs + culture not useful NAAT: 1st urine sample for men, vaginal swabs for women. Check every pos sample for macrolide resistance Test for cure

Answer 24

Slow growing swabs + culture not useful NAAT: 1st urine sample for men, vaginal swabs for women. Check every pos sample for macrolide resistance Test for cure

Answer 25

Doxy 100mg BD for 7 days (CI in pregnancy + BF) Azithromycin 1g stat then 500mg OD for 2 days, pregnancy + BF. Moxifloxacin: 499mg daily for 10 days complicated infections Pregnant: azithromycin of amoxicillin

GUM Flashcards

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