GUM Flashcards
(115 cards)
1
Q
Herpes causative organisms
A
Oral: HSV1
Genital: HSV2
2
Q
Herpes attack management
A
PO acyclovir
Avoid sex until lesions are gone
Return if symptoms persist for 10 days
3
Q
Herpes management during pregnancy
A
PO acyclovir for attacks > 28 weeks
Elective C section
4
Q
Herpes investigations
A
Best: NAAT
5
Q
Prodromal phase of herpes
A
Tingling and itching
6
Q
Thrush causative organisms
A
Candida albicans
7
Q
Medications which increase risk of thrush
A
COCP
Antibiotics
SGLT-2 inhibitors
8
Q
1st line management for thrush
A
Oral fluconazole
9
Q
3 medical conditions which increase risk of candida albicans infection
A
Diabetes
Immunosuppression
Pregnancy
10
Q
Number of episodes to meet recurrent vaginal candidiasis diagnosis
A
4 or more episodes in 1 year
11
Q
Management of recurrent vaginal candidiasis
A
Induction-maintenance regime
Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months
12
Q
Thrush in pregnancy
A
Oral fluconazole contraindicated
Cream
Intravaginal pessary
13
Q
Thrush investigations
A
Usually a clinical diagnosis
High vaginal swab
14
Q
Lichen sclerosis treatment
A
Topical dermovate
Emollients
15
Q
Lichen planus appearance
A
Purple, pruritic, polygonal papules
16
Q
BV discharge appearance + classical timing
A
Grey, thin fishy discharge
After sex
17
Q
Causative organisms of BV
A
Gardenerella vaginosis
Mycoplasma hominis
Prevotella species
18
Q
BV treatment
A
PO metronidazole 5-7 days
Alternative topical metronidazole/clindamycin
19
Q
BV investigations
A
Wet microscopy
Whiff test
20
Q
Amstel criteria
A
Clue cells
Whiff test +ve
Discharge
pH > 4.5
21
Q
What are clue cells?
A
Vaginal squamous epithelial cells coated with Gardenerella vaginosis
22
Q
BV pathophysiology
A
Loss of lactobacilli due to overgrowth of anerobic bacteria
23
Q
BV risk in pregnancy
A
Preterm birth
24
Q
BV protective factors
A
COCP
Condom use
25
BV risk factors
Excessive vaginal cleaning
Intercourse
Recent Abx
Copper IUD
Smoking
26
Trichomoniasis causative organism
Trichomonas vaginalis
Flagellated protozoan
27
BV discharge appearance
Grey, fishy discharge
28
Trichomoniasis wet microscopy
Charcoal swab
Motile trophozoites
29
Trichomoniasis cervix appearance
Strawberry cervix
Erythematous, punctate, and papilliform appearance
30
Trichomoniasis pregnancy risk
Preterm birth, LBW, vertical transmission
31
Chlamydia investigations for diagnosis
NAAT
F: vulvovaginal swab
M: 1st catch urine
32
Chlamydia antibiotics
Doxycycline 7 days
Azithromycin 3 days
33
Polymorphonuclear leukocytes associations
Gonorrhoea
34
Cause of purulent discharge
Usually STIs like chlamydia and gonorrhoea
35
Gonorrhoea antibiotics + other management
1st: IM ceftriaxone
2nd: Oral cefixime + azithromycin
Abstain from sex until 7 days after completing treatment
Follow up 1 week after for test of cure
Contact tracing
36
Most common cause of septic arthritis in adults
Gonorrhoea
37
Features of disseminated gonococcal infection
Tenosynovitis
Migratory polyarthritis
Dermatitis
38
Manifestations of gonorrhoea in neonates
Ophthalmia neonatorum
Sepsis: arthritis and meningitis
Less severe manifestations rhinitis, vaginitis, urethritis, and scalp infection at sites of previous fetal monitoring
39
Gonorrhoea microscopy findings
Gram -ve diplococci with polymorphonuclear leukocytes
40
Syphilis aetiology
Spirochaete bacteria:
Treponema pallidum
41
Syphilis: non-treponemal tests
Cardiolipin based tests
Can result in false +ves
-ve after treatment
RPR & VDRL
42
Syphilis: treponemal-specific tests
Reactive or non-reactive
Detects IgG and remains after treatment - immunity
TP-EIA, TPHA
43
Syphilis antibiotic + other management
IM benzylpenicllin
Contact tracing
44
Primary syphilis features
Chancre – painless ulcer
Local non-tender lymphadenopathy
Often not seen in women (lesion may be on cervix)
45
Secondary syphilis features
Fever, lymphadenopathy
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers (30%)
Condylomata lata (pink or grey discs)
46
Tertiary syphilis features
Gummas
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
47
Congenital syphilis features
Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
Rhagades
Keratitis, saber shins, saddle nose, deafness
48
Jarisch-Herzheimer reaction presentation + aetiology
Acute febrile reaction associated with treatment of syphilis
Sudden release of toxins from killed bacteria
49
Jarisch-Herzheimer reaction management
Resolves with 24h
Reassurance + paracetamol
50
+ve EIA, -ve RPR and -ve TPPA
False positive result
51
TP-EIA
T. pallidum enzyme immunoassay
52
TPHA
T. pallidum Haem Agglutination test
53
Condylomata accuminata
Genital warts
54
Genital warts causative organism
HPV 6 and 11
55
Genital warts diagnosis
Clinical
56
Genital warts management
Conservative if pt unbothered by appearance
Otherwise:
1st: topical podophyllum or cryotherapy (better for solitary/ keratinised)
2nd: Imiquimod
57
Genital warts method of transmission
Skin to skin contact
58
Lymphogranuloma venereum aetiology + presentation
Chlamydia strain L1, L2 or L3
Painless penile ulcer, can be tender
59
Lymphogranuloma venereum management
Doxycycline
60
Groove sign
Seen in lymphogranuloma venereum
Painful inguinal buboes
61
Pearly penile papules appearance
Uniform, smooth lesions present around coronal margin of glans
62
Circinate balanitis
Ring-shaped dermatitis associated with reactive arthritis
63
Haemophilus ducreyi appearance
Chancroid
Multiple and painful
64
Chancroid antibiotic treatment
Azithromycin
Or
Ceftriaxone
Or
Ciprofloxacin
65
Chancroid travel associations
Greenland
Tropical areas
66
HIV in pregnancy: treatment
Zidovudine orally if viral load < 50 copies/ml
Otherwise triple ART
4-6 weeks
Zidovudine also given before C-section
67
HIV in pregnancy: mode of delivery
C-section
Unless viral load < 50 copies/ml at 36 weeks
68
Diagnosing HIV
Presence of HIV antibody and HIV p24 antigen
Repeated to confirm diagnosis
69
When do HIV antibodies develop?
Usually 4-6 weeks after infection
70
How are HIV antibodies tested for?
ELISA test and confirmatory Western Blot Assay
71
When should HIV be tested for in asymptomatic patients?
4 weeks after possible exposure
If -ve, offer repeat test at 12 weeks post exposure
72
Presentation of HIV seroconversion
Sore throat
Lymphadenopathy
Maculopapular rash
Malaise, myalgia, arthralgia
Diarrhoea
Mouth ulcers
Rarely meningoencephalitis
73
When does HIV seroconversion typically occur?
3-12 weeks after infection
74
Antiretroviral therapy options
At least 3 drugs used
2 NRTI + PI/NNRTI
75
NRTI examples
Nucleoside reverse transcriptase inhibitor
Zidovudine
Abacavir
76
NRTI side effects
Peripheral neuropathy
77
Protease inhibitor examples
Indinavir
Nelfinavir
78
Indinavir side effect
Renal stones
79
Nelfinavir side effect
P450 enzyme inhibition
Diabetes
80
NNRTI examples + side effects
Non-nucleotide reverse transcriptase inhibitor
Nevirapine
Efavirenz
P450 enzyme inhibition, rashes
81
Pneumocystis pneumonia presentation
SOB
Non-productive cough
Fever
Exertional dyspnoea
82
Pneumocystis pneumonia causative organism
Pneumocystis jiroveci
83
Pneumocystis pneumonia CXR findings
Bilateral bihilar interstitial infiltrates
84
Pneumocystis pneumonia CT findings
Cysts and nodules
85
Pneumocystis pneumonia diagnostic investigations
Bronchoscopy with bronchoalveolar lavage
Grocott’s silver stain: Mexican hat appearance
86
Pneumocystis pneumonia management
Co-trimoxazole
Steroids
IV pentamidine if severe
PCP prophylaxis if CD4 < 200
87
HIV: oesophageal candiasis symptoms
Dysphagia
Odynophagia
88
HIV: oesophageal candidiasis management
Fluconazole
Itraconazole
89
HIV: diarrhoea causative organisms
Cryptosporidium + other protozoa
CMV
Giardia
Mycobacterium avium intracellulare
90
HIV opportunistic infections: CD4 count < 50
CMV retinitis
Mycobacterium avium-intracellulare
91
HIV opportunistic infections: CD4 count 50 - 100
Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma
92
HIV opportunistic infections: CD4 count 100 - 200
Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
PCP
HIV dementia
93
HIV opportunistic infections: CD4 count 200 - 500
Oral thrush – candida albicans
Shingles – herpes zoster
Kaposi sarcoma – HHV-8
Hair leukoplakia – EBV
94
HIV: CMV retinitis features
Most common ocular opportunistic infection
Reduced visual acuity
Pizza pie appearance on fundoscopy
95
CMV retinitis treatment
Intraocular injections ganciclovir
Systemic oral valganciclovir
96
HSV ocular infection features + management
Anterior or posterior segment of the eye
Permanent blindness if central area of cornea affected
Topical acyclovir
97
HIV: neurological lesions
Toxoplasmosis 50%
Primary CNS lymphoma 30%
TB less common
98
HIV: toxoplasmosis presentation
Headache
Confusion
Drowsiness
99
HIV: toxoplasmosis CT findings
Multiple ring enhancing lesions
100
HIV: toxoplasmosis management
Sulfadiazine + Pyrimethamine
101
HIV: CNS lymphoma cause
EBV
102
HIV: CNS lymphoma CT findings
Single homogenous enhancing lesion
103
HIV: CNS lymphoma treatment
Steroids
Chemo
Brain irradiation
Surgery
104
HIV: neurological TB CT finding
Single enhancing lesion
105
HIV: CT oedematous brain - what does this indicate?
Encephalitis
Caused by CMV or HIV itself
106
HIV: cryptococcus meningitis investigations + results
CSF: high opening pressure, India ink test +ve
CT: meningeal enhancement, cerebral oedema
107
HIV: cryptococcus treatment
Induction
IV Amphotericin B + Oral flucytosine
Or
Fluconazole + Oral flucytosine
Maintenance
Fluconazole
108
HIV: pathophysiology of progressive multifocal leukoencephalopathy
Oligodendrocytes infected by JCV virus
109
HIV: progressive multifocal leukoencephalopathy findings
Widespread demyelination
110
AIDS dementia complex presentation
Behavioural changes + motor impairment
111
Management of hypoactive sexual desire disorder
CBT (psychodynamic, cognitive, integrative, behavioural)
M: Testosterone replacement
F: Flibanserin if premenopausal
112
Erectile dysfunction management
1st: sildenafil (phosphodiesterase inhibitor)
2nd: alprostadil injection
Non medical: vacuum device, kegel exercises, psychotherapy
113
Female sexual arousal disorder
Failure of genital response
Reduced physical response to sex stimuli and reduced sexual pleasure
114
Management of rapid ejaculation
1st: SSRIs (dapexetine)
STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, kegel exercises)
115
Management of female orgasmic disorder
Topical oestrogens
Behavioural interventions: Guided masturbation, vibrators
