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ID+GUM+ HIV > GUM > Flashcards

GUM Flashcards

1
Q

Secondary syphilis features

A

Generalised polymorphic, maculopapular rash
- Can be on palms, soles and face

Lymphadenopathy

  • Generalised
  • Painless
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2
Q

Diagnosis of syphillis

A

Swabs from ulcer

  • Dark ground microscopy
  • PCR

Treponemal antibodies

CSF antibody testing

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3
Q

Treatment of syphilis

  • first line
  • second line
A

1st line
- IM benzathine penicillin

2nd line
- Oral doxycycline/ azithromycin

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4
Q

Jarisch–Herxheimer reaction

A

Phenomenon that can occur after IM benzathine penicillin treatment for syphilis due to release of endotoxins

  • Typically resolves within 24 hours
  • Common in early syphilis

Features

  • Headache
  • Myalgia
  • Chills/ rigors
  • Tachycardia
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5
Q

Neurosyphilis

  • Onset
  • Features
A

Occurs 10+ years after infection

Features

  • Meningitis
  • Psychosis/ Dementia
  • Tabes dorsali= dorsal column involvement–> sensory ataxia, weakness, charcot joints
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6
Q

Latent (tertiary) syphilis features

A

Neurosyphilis

Cardiovascular

  • Aortic regurgitation/ aneurysm
  • Angina

Gummata
- fibrous nodules/ plaques in connective tissue

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7
Q

Argyll-Robertson pupil

A

Bilateral, small pupils that accommodate to near object but does not constrict to light.

Features of neurosyphilis

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8
Q

HIV seroconversion presentation

A

Viral-like illness

  • Fever
  • Myalgia, arthralgia
  • Pharyngitis
  • Lymphadenopathy

Maculopapular rash

GI
- Diarrhoea, vomiting

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9
Q

Incubation period for secondary syphilis

A

6 weeks +

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10
Q

Incubation period for seroconversion illness in HIV

A

2-12 weeks

- Most commonly in 2-4 weeks

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11
Q

Opportunistic infections in HIV

  • Skin
  • Oral
  • Respiratory
  • Neurological
A

Skin

  • Seborrhoeic dermatitis
  • Shingles
  • HSV
  • Tinea

Oral

  • Candidiasis
  • Oral hairy leucoplakia (EBV)

Respiratory
- TB

Neurological

  • Peripheral neuropathy
  • Myelopathy
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12
Q

AIDS defining illnesses

  • Pulmonary
  • Neurological
  • Malignancy
  • Dermatology
A

Pulmonary

  • Pneumocystic pneumonia
  • Gram-negative Bacterial pneumonia

Neurological

  • Cryptococcus
  • Cerebral toxoplasmosis
  • HIV encephalopathy

Malignancy

  • Kaposi sarcoma
  • Hodgkins Lyphoma
  • Hepatocellular carcinoma

Dermatology
- Molluscum contagiosum

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13
Q

Pneumocystis pneumonia

  • Causative agent
  • Presentation
A

Pneumocystis jirovecci

  • Unicellular eukaryotic fungus
  • AIDS defining illness (CD4< 200)

Presentation
- SoB on exertion
- Chronic, drug cough
-

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14
Q

Investigation findings for pneumocystic pneumonia

A

Chest X-ray

  • Bilateral hilar shadowing/ infiltrate
  • Interstitial shadowing

Bronchoalveolar lavage
- Silver stain microscopy

Exercise oximetry
- Below <90% on exertion

ABG
- Type 1 respiratory failure

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15
Q

First line treatment of pneumocystic pneumonia

A
  1. Co-trimoxazole (Septrin)
    - 2-3 weeks
    - Add antiemetics
  2. High flow Oxygen
  3. Steroids if pO2 < 8kPa
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16
Q

Alternative therapies for pneumocystic pneumonia

A

Septin allergy

- Clindamycin and Promaquine

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17
Q

PCP prophylaxis

  • Indications
  • Drug and dose
A

Following 3 weeks of treatment in patients with CD4 < 200

  • Septrin 480mg OD
  • 2nd line = Dapsone 100mg OD

Other indications

  • CD4 % < 14
  • Previous PCP diagnosis on 2 occasions
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18
Q

3 Largest risk groups for HIV in UK

A
  1. MSM
  2. Heterosexual sex in Sub-Saharan Africa
  3. IVDU
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19
Q

Septrin side effects

A

Common= Nausea and vomiting.

  • rash
  • bone marrow suppression
  • hepatotoxicity
  • hypoglycaemia and haemolytic anaemia in patients with G6PD deficiency.
20
Q

HIV window testing period

A

Serology

  • May take up to 3 months for postive results (point of care, rapid test)
  • 45 days in lab

4th generation lab test

  • 95% sensitivity
  • Should be offered initially

Everyone retested after 12 weeks,

21
Q

Lymphogranunolma venereum is caused by…

A

C. trachomatis L1-3

22
Q

Presentation of LGV

A

Painless ulcers/ pustules in anus/ genital region

Painful, regional lymphadenopathy

Rectal symptoms

  • Proctitis
  • Purulent rectal discharge
  • Tenesmus
  • Rectal pain
23
Q

Treatment of Chlamydia

A

Oral doxycycline 100mg BD
- 1 week

PID/ Epididymo-orchitis
- 2 weeks

LGV
- 3 weeks

24
Q

Bacterial vaginosis risk factors [7]

A
  • New/ multiple sexual partners
  • Smoking
  • Douching/ washing with soap
  • IUD/ IUS insertion
  • Concurrent STI
  • Receptive oral sex
  • Afro-Caribbean
25
Q

Presentation of BV

A

Malodorous, thin grey vaginal discharge

- pH < 4.5

26
Q

Investigation findings for BV

A

pH of discharge >4.5

Gram staning of vulvovaginal swab, using Hay/Ison criteria
- Clue cells

27
Q

Investigation for trichomoniasis

A

Posterior fornix swab

- Wet mount microscopy

28
Q

Treatment for bacterial vaginosis

A

First line= metronidazole

  • 400mg BD for 5 days
  • Oral 2g STAT
  • Intravaginal gel 0.75%

Clindamycin

  • 300mg BD PO for 7 days
  • Intravaginal 2% OD

Tinidazole 2g STAT

29
Q

Thrush treatment

A

Clotrimazole

  • Vaginal pessary 500mg STAT
  • 200mg pessary 3/7
  • Topical cream + oral fluconazole/ clotrimazole pessary

Fluconazole
- 150mg PO STAT

30
Q

Thrush in pregnancy

  • Prevalence
  • Treatment
A

Prevalence

  • Asymptomatic Candida colonisation is more common (30-40%)
  • Symptomatic presentation is more prevalent

Treatment= longer courses
- Clomitrazole pessary 500mg OD 7 days

31
Q

Recurrent vulvovaginal candidiasis

  • Definition
  • Pathology
  • Investigation
  • Treatment
A

At least 4 episode of thrust a year with some resolution in between

Pathology

  • Linked to allergy and pro-inflammatory markers
  • Risks: diabetes, immunosuppression, hyperoestrogenaemia, distruption of flora.

Investigations
- Gram-staining and culture for speciation

Treatment

  • Induction: Fluconazole 150mg every 3 days x3
  • Maintenance= Oral Fluconazole 150 mg OW for 6 months
32
Q

Treatment of C glabrata thrush

A

Fluconazole/ boric acid vaginal pessaries

Longer anti-fungal courses

33
Q

Causes of haematospermia

A

Urethritis

Proctitis

Prostate biopsy

Severe hypertension

Malignancy

34
Q

In patients infected with syphillis, _____ serology will always be positive

A

Treponemal enzyme immunoassay (EIA)

35
Q

____ and ____ are markers of active syphyllis infection

A

VDRL and RPR

- Higher dilution = more active infection

36
Q

Causes of genital warts

A

HPV 6 and 11

37
Q

_________ is used first line for keratinised genital warts

A

Podophyllotoxin

38
Q

________ is used first line for keratinised warts, whilst _______ is second-line

A 
1st= imiquimod cream
2nd= Ablative cryotherapy
39
Q

______ or _______ are first line for urethral HPV warts with visible base.

A

Topical imiquimod or cryotherapy ablation

40
Q

________ is required to treat urethral HPV warts with a base that is not visible.

A

Urological referral

41
Q

_______ is first line for internal HPV warts whilst ______ is second-line

A

Cryotherapy is first line

Surgical excision is 2nd line.

42
Q

Transmission of genital herpes

A

Can be transmitted whilst asymptomatic (asymptomatic shedding)

43
Q

Acute management of genital herpes

A

Symptomatic relief

  • Saline baths
  • Simple analgesia
  • Topical anaesthesia

Oral aciclovir

44
Q

Management of recurrent genital herpes

A

Counselling

HIV test = rule out immunosupressive cause

Aciclovir

  • Daily for suppressive treatment
  • During attacks for episodic treatment
45
Q

Neonatal herpes has a _____ mortality, especially if mother contracts herpes ______

A

High mortality

- Worse if herpes is contracted during pregnancy

ID+GUM+ HIV (12 decks)

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