gyn Flashcards
(53 cards)
Pneumocystis Jiroveci pneumonia lab finding
silver stain of fungus
A pelvic mass with complex papillary architecture, nuclear atypia and the presence of Psammoma bodies is indicative of a
serous cystadenocarcinoma, which is the most common subtype of epithelial ovarian cancer.
Cervical screening: borderline or abnormal cells on cytology always indicate a
colposcopy referral.
Past CIN2, but positive smear next steps
After cervical intraepithelial neoplasia (CIN) 2 has been treated, patient will be referred back to colposcopy if HPV smear is positive on re-screening after 6 months, regardless of cytology.
Lymphogranuloma venereum presents with
a painless genital ulcer and unilateral inguinal lymphadenopathy, typically requiring doxycycline for treatment.
A sexually transmitted infection characterised by small, painless, fleshy papules with central indentation on the genital area is most likely
Molluscum contagiosum.
What is the gold standard for confirming a diagnosis of Pneumocystis jirovecii pneumonia.
Bronchoalveolar lavage is the gold standard for confirming a diagnosis of Pneumocystis jirovecii pneumonia.
An 86-year-old man presents to his General Practitioner with a one-year history of a gradually growing skin lesion affecting his foot. He was born in Cyprus and lived there for most of his adult life. He has a history of hypertension and type 2 diabetes, which are well-controlled.
On examination, there is a large purple-red macule on the dorsal surface of his left foot.
Which of the following is the underlying cause?
Human herpesvirus 8 (HHV-8) infection
This is a case of classical Kaposi’s sarcoma caused by HHV-8 infection. Kaposi’s sarcoma is a vascular tumour that often presents as purple-red macules or nodules on the skin, commonly affecting the lower extremities. This form of Kaposi’s sarcoma is typically seen in elderly men of Mediterranean or Eastern European descent. The patient’s demographic background and the presentation of a purple-red macule on the foot are consistent with classical Kaposi’s sarcoma, making HHV-8 the underlying cause.
A 66-year-old woman presents with sharp pain on defecation and occasional blood on toilet paper. She denies weight loss or changes in bowel habits.
She has a past medical history of type 2 diabetes which is well-controlled on metformin, hypertension and eczema.
On examination, her abdomen is soft and non-tender. Genital exam reveals smooth, dry vulva with porcelain-white shiny areas, particularly on the left. The labia minora and clitoris are not visible, and the labia majora are thickened with red patches. Linear lacerations are present at the posterior fourchette and external anal sphincter.
Digital vaginal examination is not possible. Digital rectal examination reveals no masses and soft stool in the rectum.
What is the most appropriate next step?
Vulval biopsy
This woman has features of lichen sclerosus, an inflammatory skin condition that often affects the vulva. It appears as hypopigmentation of the vulval and perianal skin, characteristically appearing in a “figure of eight” distribution. In severe cases, thickening and scarring occurs, which can completely obliterate vulval structures such as the labia minora and clitoris. Fissures are common, particularly around the posterior fourchette (the thin, v-shaped tissue joining the labia minora inferiorly). Fissures can easily tear and cause discomfort and bleeding.
Vulval biopsy should be performed to confirm the diagnosis of lichen sclerosus. Lichen sclerosus carries an increased risk of vulval intraepithelial neoplasia (VIN) and squamous cell carcinoma. In this case in particular, the distribution of the hypopigmentation is not well-demarcated or symmetrical, raising a concern of pre-cancerous or cancerous changes.
A 53-year-old woman presents to accident and emergency with acute onset right iliac fossa pain. She is taken for an emergency laparoscopy which reveals acute ovarian torsion and a right ovarian mass. She undergoes a right oophorectomy and makes a good recovery postoperatively. Pathology of the ovary reveals a mass containing an invasive proliferation of mucin-producing signet-ring cells.
Which of the following cancers should now be screened for?
Gastrointestinal cancers
Krukenberg tumours of the ovary refer to a tumour containing “signet ring” cells. This is typically a gastrointestinal carcinoma, which has metastasised to the ovary.
chlamydia in breast feeding mother
oral azithromycin
A 31-year-old woman attends the gynaecology clinic to receive the results of her most recent smear test. The results are positive for HPV with normal cytology. She has had normal smears previously. The patient asks what the next steps would be for her ongoing management.
What is the most appropriate next step in the management of this patient?
Reassure the patient and repeat the smear test in 12 month’s time
This is correct. This patient has HPV and and requires closer monitoring until she no longer tests positive for HPV. Guidelines suggest repeat smear testing in 12 month’s time.
A woman with discomfort during urination, irritation around the vulva, and painful sexual intercourse, alongside multiple sexual partners and inconsistent condom use, may have what characterised by what
Trichomonas vaginalis infection, characterised by a strawberry cervix and motile pear-shaped parasites under microscopic examination.
BV pregnancy complications
Preterm rupture of membranes and premature labour are accepted risks of this infection
mid trimester miscarriage
how to confirm herpes diagnosis
Nucleic acid amplification test
nulliparity increases risk of
endometrial cancer
thrush
oral fluconazole
In immunocompromised patients, such as those with HIV and a low CD4 count, Mycobacterium avium intracellulare can cause
abdominal pain due to lymph node enlargement, resulting in elevated levels of alkaline phosphatase and lactate dehydrogenase.
random AIDS defining infection
oesophageal candidiasis
A 40-year-old man presents to the general practitioner with a penile ulcer and fever. In addition, he reports unprotected insertive anal intercourse with a casual male partner three weeks prior.
On examination, there is a small painless ulcer on the glans of his penis and palpable inguinal lymphadenopathy. There is no associated penile discharge.
The man receives antibiotics, and a follow-up is arranged for two weeks.
Unfortunately, the following day, the patient returns feeling more unwell, with a higher fever, high heart rate, and a widespread rash.
There is no respiratory compromise.
What is the most appropriate management?
Reassurance and paracetamol
The patient likely has primary syphilis and has received intramuscular benzylpenicillin. He has then presented with a Jarisch-Herxheimer reaction which is usually self-resolving, and no treatment is needed unless the symptoms are severe.
A 34-year-old woman presents with postcoital bleeding and non-specific suprapubic pain. A PV examination detects pevlic bulkiness.
Which of the following is a risk factor for the likely diagnosis?
Tobacco use
This is correct. The patient’s presentation of postcoital bleeding, non-specific suprapubic pain, and pelvic bulkiness raises suspicion for cervical cancer. Tobacco use is a well-established risk factor for cervical cancer, as it impairs the immune system’s ability to clear human papillomavirus (HPV) infections, which are the primary cause of cervical cancer. Smoking increases the likelihood of developing cervical cancer, making it a significant risk factor.
What is the most appropriate initial investigation to confirm a diagnosis of a ruptured ovarian cyst.
A transvaginal ultrasound is the most appropriate initial investigation to confirm a diagnosis of a ruptured ovarian cyst.
A 23 year old woman is brought to A&E with sudden onset lower abdominal pain and vomiting. She has no past medical history.
She has a low-grade fever and is tachypnoeic. On examination, there is a palpable adnexal mass which is tender.
What is the most appropriate next step?
pregnancy test
A urethral smear with 5 or more polymorphs per high power field and no evidence of gram negative diplococci indicates
chlamydia infection, which should be treated empirically with doxycycline.
