gyn1 Flashcards
(39 cards)
syphilis vs chancroid
Syphilis -Treponema pallidum. single ulcer, termed chancre, that is painless. No lymphadenopathy
Chancroid- multiple painful ulcers with associated painful lymphadenopathy are present. Haemophilus ducreyi
Donovanosis presentation and Mx
This would present with multiple small painless nodules, which then burst leading to a pustular appearance with exudate
Co - trimoxazole
A 35 year old Fijian man visits the GUM clinic. He has noticed a small genital ulcer that is painless.
On genital examination, there is unilateral inguinal lymphadenopathy.
Given the likely diagnosis, what is the most appropriate management?
Doxycycline
Lymphogranuloma venereum (LGV).
small, single painless ulcer and unilateral lymphadenopathy.
A 28 year old male presents to the genitourinary medicine clinic with a 3 day history of purulent anal discharge with fresh rectal bleeding and rectal pain. His symptoms are relatively severe and are impacting his quality of life. He has regular unprotected anal sexual intercourse.
On examination there is evidence of tender, inflamed local lymph nodes and he was unable to tolerate rectal examination.
What is the most likely cause of his symptoms?
Lymphogranuloma venereum
This patient has lymphogranuloma venereum (LGV) proctitis. It is the most common cause of proctitis amongst homosexual males. LGV is caused by chlamydia trachomatis.
Rectal gonorrhoea tends to be less severe than LGV proctitis. Often it is asymptomatic and tends not to present with tender lymphadenopathy.
In anorectal herpes simplex, the pain is often out of proportion to other proctitis symptoms. It is less common but can present similarly.
Chancroid ulcer and bacteria
Gram-negative rods in a typical “school of fish” pattern. Anaerobic. Haemophilus ducreyi.
Ulcer:
An erythematous papule forms at the site of inoculation, which soon develops into a pustule and then into an excruciatingly painful ulcer, which has a friable base and yellow-grey exudate.Deep ulcer with a soft, irregular border and a friable base
sudden-onset abdominal pain, which typically starts during exercise (such as physical activity or sexual intercourse)
ovarian cyst rupture
early stage cervical cancer in woman who wants more children Mx
For early-stage cervical cancer, a radical trachelectomy is a viable treatment option and also preserves reproductive abilities. remove cervix and nearby tissues
PID more likely to cause
ectopic pregnancy than miscarriage
24F, 4 day history of abdominal cramps, thick yellow vaginal discharge. Multiple sexual partners.
O/E: cervical tenderness, inflamed cervix, thick yellow/green discharge in vaginal vault
microscopy findings?
Intracellular gram-negative diplococci
This patient has signs and symptoms of pelvic inflammatory disease. Gram-negative diplococci inside cells on a vaginal specimen indicate gonorrhoea infection, one of the most common causes of pelvic inflammatory disease.
normal to find
gram + baciilli
gram + cocci =
BV
most common ovarian cyst
functional - follicular
fever, rash, and worsening of existing symptoms due to the release of toxins from dying Treponema pallidum bacteria.
The Jarisch-Herxheimer reaction is a potential complication of treatment for syphilis characterised by
is oral acyclovir 400mg 3 x a day contra indicated in pregnancy
no
A 60 year old woman presents to the GP with a 2 month history of early satiety and bloating. She is otherwise very well with no comorbidities. She has a CA 125 test - result 100 and undergoes urgent abdominal and pelvic ultrasound.
A mixed solid and cystic mass is present on ultrasound and she undergoes MRI staging.
What is the most appropriate next step in her management?
Surgery
This is recommended for histological confirmation, staging and tumour debulking.
Nabothian cysts
are normal cervical findings in women, appearing as small, amber mucous-filled cysts around the cervical os, resulting from epithelial transition areas that secrete and trap mucous.
cervical polyps- cherry red, 40-50y/o post children
A 38-year-old HIV positive man comes to the emergency department with headache and fever for the last two days. He denies neck stiffness and photophobia. A CT Head shows multiple ring enhancing lesions with no mass effect.
What is the most appropriate course of action?
Administer sulfadiazine and pyramethamine
This case describes a most likely case of toxoplasmosis due to the neuroimaging findings as multiple ring enhancing lesions in HIV are virtually diagnostic of toxoplasmosis. This is the correct answer, as treating toxoplasmosis often involves medical management and monitoring to see whether imaging and symptoms improve. Folate is often co-adminstered with sulfadiazine as it can lead to folate deficiency.
ovarian torsion Ix
pelvic US with doppler
PCOS and cancer
PCOS is thought to increase the risk of both endometrial and ovarian cancer by about two to three times.
A palmar and plantar rash with generalised lymphadenopathy and a history of unprotected sex are suggestive of
secondary syphilis. The British Association for Sexual Health and HIV (BASHH) recommend EIA/treponemal chemiluminescent assay (CLIA) as the screening test of choice for syphilis.
A 32 year old woman visits the GUM clinic. She reports that her husband engaged in receptive anal sex 48 hours ago and she has since slept with him without using a condom. She is concerned that she may have contracted HIV and is requesting post-exposure prophylaxis (PEP) therapy. She has no other medical issues, normal renal function and has never had PEP before.
What is the most appropriate initial management of this patient?
Determine HIV status before prescribing PEP therapy
This is correct. HIV testing is required to confirm that patients are not already HIV-positive when they start taking PEP. This helps in monitoring and provides a reference for future testing. In line with BASHH guidelines, clinicians should consider PEP when there is a significant risk of HIV transmission. This includes situations where an individual has had unprotected sexual intercourse with a partner who is known to be HIV-positive or whose HIV status is unknown but engages in high-risk behaviors.
A 22-year-old male presents to the GP with a 2 day history of a ‘burning’ sensation when passing urine. He denies any haematuria or testicular changes, but admits he has noticed some discharge from the tip of the penis. Urethral swab and urine cultures are sent.
Given the likely diagnosis, which of the following complications is this patient at risk of?
urethral stricture from urethritis caused by STI
A 37-year-old gentleman presents to the sexual health clinic with a painful ulcer in his penis. There is no associated discharge.
He states he has recently returned from a holiday to Zambia. He reports having sex with multiple partners during his stay there, but he used condoms at all times.
His blood results come back as normal, aside from mildly raised inflammatory markers.
What is the most likely diagnosis?
Haemophilus ducreyi infection
This man likely has chancroid, a sexually transmitted infection caused by Haemophilus ducreyi and is spread via skin-to-skin contact with affected areas. It is more common in the tropics.
LGV would be painless ulcer and painful inguinal lymphadenopathy and proctocolitis
In patients with suspected Pneumocystis pneumonia, especially those with prior HIV exposure or a history of splenectomy, initiation of
Co-trimoxazole therapy and corticosteroids is crucial for improving outcomes, particularly when oxygen saturations are below acceptable ranges.
