gynae Flashcards
(306 cards)
1
Q
fibroid tumours are benign tumours of the
A
smooth muscle
2
Q
fibroids are sensitive to which hormone?
A
oestrogen
3
Q
common presentation for a fibroid
A
menorrhagia, prolonged menstruation, abdominal pain, bloating, urinary/bowel symptoms, deep dyspareunia and reduced fertility.
4
Q
the initial investigation for submucosal fibroid with menorrhagia should be
A
hysteroscopy
5
Q
what imaging may be considered and why for fibroids?
A
US - larger fibroids
MRI - surgical options
6
Q
for fibroids less than 3cms first line tx
A
mirena coil
7
Q
alt. Tx for fibroids less than 3cms
A
symptomatic (NSAIDS + Tranexamic acid), COCP, cyclical oral progestogens
8
Q
surgical options for fibroids that cause menorrhagia
A
endometrial ablation, resection and hysterectomy
9
Q
surgical options for large fibroids include
A
uterine artery embolisation, myomectomy, hysterectomy
10
Q
why may GnRH agonists be used for treatment of fibroids
A
reduce the size of the fibroids by inducing a menopausal state usually for prior to surgery
11
Q
what diagnosis would you consider in a pregnant women with a history of fibroids presenting with severe abdominal pain and low grade fever
A
red degeneration of fibroids
12
Q
red degeneration of fibroids refer to
A
ischaemia, infarction and necrosis of fibroids commonly larger than 5cm.
13
Q
management of red degeneration of a fibroid includes
A
supportive; rest, fluid and analgesia.
14
Q
hypogonadotropic hypogonadism refers to
A
deficiency of LH and FSH
15
Q
hypergonadotropic hypogonadism refers too
A
lack of response by the gonads
16
Q
causes of hypogonadotropic hypogonadism includes
A
hormonal (pituitary or endocrine), inflammation (pituitary, hypothalamus, chronic conditions), constitutional (diet, delay, exercise), or kallman syndrome
17
Q
causes of hypergonadotropic hypogonadism
A
gonad damage, absence of gonads or turner syndrome
18
Q
congenital adrenal hyperplasia is caused by
A
congenital deficiency of 21-hydroxylase enzyme resulting in underproduction of cortisol and aldosterone and overproduction of androgens from birth
19
Q
genetic inheritance of congenital adrenal hyperplasia
A
autosomal recessive
20
Q
symptoms acutely for congenital adrenal hyperplasia
A
electrolyte disturbances and hypoglycaemia
21
Q
later typical features of congenital adrenal hyperplasia
A
tall for age, facial hair, absent periods, deep voice, early puberty
22
Q
androgen insensitivity syndrome results in
A
female phenotype but absent uterus, female sex organs and the presence of internal testes
23
Q
initial investigations for primary amenorrhoea
A
FBC, ferritin, U+E’s, Anti-TTG and Anti ENA for coeliac disease
24
Q
hormonal blood tests for primary amenorrhoea
A
FSH, LH, Thyroid function tests, insulin like growth factor 1 for GH deficiency, prolactin and testosterone (PCOS)
25
use of imaging for primary amenorrhoea
X-ray of wrist for constitutional delay, pelvic US, MRI for kallman or pituitary pathology.
26
TX for primary amenorrhoea
replacement hormones, reduction in stress, weight gain, CBT and COCP
27
TX for kallman syndrome or hypogonadotrophic hypogonadism
pulsatile GnRH
28
secondary amenorrhoea is defined as
no menstruation for more than three months or 3-6 months if prior evidence of irregular periods
29
causes of secondary amenorrhoea
```
Pregnancy
Menopause
Hormonal contraception
Hypothalamic or pituitary
PCOS
Uterine pathology such as Asherman’s syndrome
Thyroid pathology
Hyperprolactinaemiq
```
30
treatment for hyperprolactinaemia
bromocriptine and cabergoline
31
assessment of secondary amenorrhoea
history and examination, hormonal blood tests and US (PCOS)
32
hormonal tests for secondary amenorrhoea
FSH, LH, prolactin, TSH, and testosterone
33
secondary amonerrhoea high FSH suggests
primary ovarian failure
34
secondary amonerrhoea high LH suggests
PCOS
35
when secondary amenorrhoea lasts for longer than 12 months women are at risk for
osteoporosis
36
Tx for physical symptoms of premenstrual cycle
spironolactone
37
cyclical breast pain treatment
danazole and tamoxifen
38
Tx for PMS
lifestyle changes, COCP, SSRI's, CBT
39
with severe symptoms and failure of medical management for PMS consider
Hysterectomy and bilateral oophorectomy with HRT post-op
40
gynaecological history questions
```
age of menarche
cycle length
intermenstrual and post coital bleeding
contraceptive history
sexual history
pregnancy/plans
cervical screening
migraines
PMH, drug history, smoking, alcohol
FH
```
41
with heavy menstrual bleeding what examinations should be carried out?
pelvic, speculum and bimanual with FBC
42
outpatient hysteroscopy should be arranged if
Suspected submucosal fibroids
Suspected endometrial pathology, such as endometrial hyperplasia or cancer
Persistent intermenstrual bleeding
43
pelvic and transvaginal US should be arranged if
Possible large fibroids (palpable pelvic mass)
Possible adenomyosis (associated pelvic pain or tenderness on examination)
Examination is difficult to interpret (e.g. obesity)
Hysteroscopy is declined
44
symptomatic relief outwith contraception for heavy menstrual bleeding consider
tranexamic acid and mefenamic acid
45
contraceptive options for heavy menstrual bleeding
mirena coil, combined COCP, cyclical oral progestogens
46
final options for heavy menstrual bleeding
endometrial ablation (balloon thermal) or hysterectomy
47
potential causes of endometriosis
retrograde menstruation, embryonic cells, lymphatic spread and metaplasia
48
endometriosis adhesions lead to which symptoms
chronic non-cyclical pain and reduced fertility possibly.
49
presentation of endometriosis
Cyclical abdominal or pelvic pain
Deep dyspareunia (pain on deep sexual intercourse)
Dysmenorrhoea (painful periods)
Infertility
Cyclical bleeding from other sites, such as haematuria
50
gold standard diagnosis for endometriosis
laparoscopic surgery with biopsy of lesions
51
Stage 1 endometriosis
small superficial lesion
52
stage 2 endometriosis
mild, but deeper lesions than stage 1
53
stage 3 endometriosis
deeper lesions with lesions on the ovaries and mild adhesions
54
stage 4 endometriosis
deep and large lesions affecting the ovaries with extensive adhesions
55
hormonal management of endometriosis
COCP, POP, depo-provera, implant, mirena coil, GnRH agonists
56
surgical management of endometriosis
laparoscopic surgery or hysterectomy with bilateral salpingo-oopherectomy
57
adenomyosis presents with
painful heavy periods and dyspareunia
58
1st line investigation for adenomyosis
transvaginal ultrasound
59
gold standard diagnostic method for adenomyosis is
histological examination after hysterectomy
60
alternatives for transvaginal US for adenomyosis
MRI and transabdominal US
61
Tx for adenomyosis that is painless but don't want contraception
tranexamic acid
62
Tx for for adenomyosis that is painful but don't want contraception
mefenamic acid + NSAIDS
63
management for adenomyosis
mirena coil, COCP, cyclical oral progestogens
64
specialists options for adenomyosis
GnRH analogues, endometrial ablation, uterine artery embolisation, and hysterectomy
65
premature ovarian insufficiency is characterised as
hypergonadotropic hypogonadism
66
hormone analysis of premature ovarian insufficiency shows
raised LH and FSH but low oestradiol levels
67
hormone analysis of menopause will show
low oestrogen and progesterone but high LH and FSH
68
after the last menstrual period how long should contraception should be continued
1 year over 50, 2 years under 50
69
acceptable forms of contraception for menopausal women
```
Barrier methods
Mirena or copper coil
Progesterone only pill
Progesterone implant
Progesterone depot injection (under 45 years)
Sterilisation
```
70
two key side effects of depo injections
reduced bone mineral density and weight gain
71
symptom management of perimenopausal symptoms
HRT, clonidine, CBT, SSRI (citalopram or fluoxetine), testosterone, vaginal oestrogen, vaginal moisturisers
72
the rotterdam criteria is for
PCOS diagnosis and it requires all three criteria to be met for diagnosis
73
all three points for the rotterdam diagnosis of PCOS
oligoovulation or anovulation, hyperandrogenism, and polycystic ovaries on ulstrasound.
74
presentation of PCOS
```
Oligomenorrhoea or amenorrhoea
Infertility
Obesity (in about 70% of patients with PCOS)
Hirsutism
Acne
Hair loss in a male pattern
```
75
differentials for PCOS
Medications, such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
Ovarian or adrenal tumours that secrete androgens
Cushing’s syndrome
Congenital adrenal hyperplasia
76
how does insulin resistance relate to PCOS
increased insulin:
promotes androgen release
suppresses sex hormone binding globulin from the liver
halts development of follicles
77
hormonal investigations for PCOS
```
Raised luteinising hormone
Raised LH to FSH ratio (high LH compared with FSH)
Raised testosterone
Raised insulin
Normal or raised oestrogen levels
```
78
US appearance of PCOS
string of pearls (12 or more) and ovarian volume of more than 10cm cubed.
79
general management of PCOS
Weight loss
Low glycaemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)
80
PCOS increases risk for which cancer?
endometrial
81
why does PCOS increase risk for endometrial cancer?
unopposed oestrogen due to anovulation resulting in reduced progesterone.
82
options for reducing risk of endometrial hyperplasia in PCOS includes
mirena coil, cyclical progestogens and COCP
83
use of metformin in PCOS is for
fertility
84
treatment for hirsutism in PCOS
spironolactone
85
management for Acne in PCOS
COCP, as well as oral tetracycline, topic antibiotics or topical azelaic acid.
86
presentation of ovarian cyst
Pelvic pain
Bloating
Fullness in the abdomen
A palpable pelvic mass
87
most common type of ovarian cyst is
follicular
88
appearance of a follicular cyst on US
thin walls with no internal structure
89
common cyst to appear in early pregnancy
corpues luteum cyst
90
ovarian cysts Serous Cystadenoma is
benign epithelial tumour
91
Dermoid Cysts / Germ Cell Tumours is
benign teratoma of germ cells
92
Sex Cord-Stromal Tumours
rare connective tissue tumour may be benign or malignant
93
features that hint at malignany
```
Abdominal bloating
Reduce appetite
Early satiety
Weight loss
Urinary symptoms
Pain
Ascites
Lymphadenopathy
```
94
risk factors for ovarian malignancy
```
Age
Postmenopause
Increased number of ovulations
Obesity
Hormone replacement therapy
Smoking
Breastfeeding (protective)
Family history and BRCA1 and BRCA2 genes
```
95
ovarian cancer tumour marker
CA125
96
tumour markers for germ cell tumour
```
Lactate dehydrogenase (LDH)
Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)
```
97
Meig's syndrome is a triad of
Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites
98
ovarian torsion is usually due to a mass larger
5cm
99
presentation of ovarian torsion
sudden onset severe unilateral pelvic pain +/- nausea and vomiting. localised tenderness and mass.
100
US appearance of ovarian torsion
whirlpool sign of free fluid.
101
definitive diagnosis of ovarian torsion is by
laparoscopic surgery
102
treatment of ovarian torsion is by
laparscopic surgery
103
women with a uterus and HRT require
endometrial protection with progesterone
104
women without a uterus and HRT require
oestrogen only HRT
105
women with periods and HRT require
cyclical progesterone with breakthrough bleeds
106
HRT - postmenopausal women with a uterus and 12 months without a bleed require
continuous combined HRT
107
use of clonidine for menopausal symptoms is for
vasomotor symptoms and hot flushes (Alpha 2-adrenergic receptor agonist)
108
long term use of HRT for over 60's risks
endometrial, ovarian and breast cancer. VTE, stroke and coronary artery disease.
109
risk reduction of HRT cancers through
local progestogens
110
VTE risk of HRT reduced through
patches rather than pills for oestrogen
111
CI for HRT
```
Undiagnosed abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled hypertension
Venous thromboembolism
Liver disease
Active angina or myocardial infarction
Pregnancy
```
112
mirena coil is licensed for how many years
four
113
C19 progestogens are derived from
testosterone
114
C21 progestogens are derived from
progesterone
115
when should oestrogen contraceptives or HRT be stopped for surgery
4 weeks prior
116
oestrogenic SE
```
Nausea and bloating
Breast swelling
Breast tenderness
Headaches
Leg cramps
```
117
progetogenic SE
```
Mood swings
Bloating
Fluid retention
Weight gain
Acne and greasy skin
```
118
Asherman's syndrome refers to
uterine adhesions post trauma commonly pregnancy, infection or surgical.
119
Asherman's syndrome presents with
Secondary amenorrhoea (absent periods)
Significantly lighter periods
Dysmenorrhoea (painful periods)
120
diagnosis and treatment of Asherman's syndrome is by
hysteroscopy
121
cervical ectropion refers too
cervical erosion resulting in the extension of the columnar epithelium of the endocervix extending out to the ectocervix
122
presentation of cervical ectropion
younger women pregnant or on COCP either asymptomatic or with discharge, vaginal bleeding, dyspareunia and post coital bleeding.
123
presentation of cervical ectropion of speculum
demarcted border between redder velvety columnar epithelium and pale pink squamous epithelium
124
management of cervical ectropion
asymptomatic - nothing
| Trouble with bleeding - cauterisation.
125
Nabothian cysts are
trapped mucous of the columnar epithelium by squamous epithelium. asymptomatic benign finding.
126
rectoceles are caused by a defect in the
posterior vaginal wall
127
cystoceles caused by defects in the
anterior vaginal wall
128
risk factors for a prolapse
Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause status
Obesity
Chronic respiratory disease causing coughing
Chronic constipation causing straining
129
presentation of prolapse
A feeling of “something coming down” in the vagina
A dragging or heavy sensation in the pelvis
Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
Bowel symptoms, such as constipation, incontinence and urgency
Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
130
what speculum would you use for investigation of a prolapse
Sim's speculum.
131
grade classification of pelvic organ prolapse
POP Q grade
132
POP Q grade 1
the lowest part is more than 1cm above the vaginal canal (introitus)
133
POP Q grade 2
The lowest part is within 1cm of the introitus
134
POP Q grade 3
The lowest part is more than 1cm below the introitus, but not fully descended
135
POP Q grade 4
Full descent with eversion of the vagina
136
A prolapse extending beyond the introitus (vaginal canal) can be referred to as .
uterine procidentia.
137
management for a prolapse
Conservative management
Vaginal pessary
Surgery
138
urge incontinence is caused by
overactivity of the detrusor muscle of the bladder
139
stress incontinence is due to
weakness of the pelvic floor and sphincter muscles
140
overflow incontinence occurs when
there is chronic urinary retention due to an outflow obstruction
141
potential causes for overflow incontinence
anticholinergic medications, fibroids, pelvic tumours, neurological conditions, MS and diabetic neuropathy
142
risk factors for urinary incontinence
```
Increased age
Postmenopausal status
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions, such as multiple sclerosis
Cognitive impairment and dementi
```
143
modifiable lifestyle factors for incontinence
Caffeine consumption
Alcohol consumption
Medications
Body mass index (BMI
144
how to assess severity of incontinence by asking about
Frequency of urination
Frequency of incontinence
Nighttime urination
Use of pads and changes of clothing
145
the modified oxford grading system is for
strength of pelvic muscle contractions during a bimanual examination
146
investigations for incontinence
bladder diary, urine dipstick testing, post-void residual bladder volume and urodynamic testing
147
management of stress incontinence involves
pelvic floor exercises
duloxetine
surgery
148
surgical management of stress incontinence involves
tension free vaginal tape (TVT), colposuspension, sling procedure, intramural urethral bulking.
149
management of urge incontinence
bladder retraining, anticholinergic medication, mirabegron, invasive options
150
anti cholinergics side effects
dry mouth, dry eyes, urinary retention, constipation and postural hypotension. Importantly they can also lead to a cognitive decline, memory problems and worsening of dementia,
151
mirabegron is CI in
uncontrolled hypertension as may lead to a hypertensive crisis
152
invasive options for overactive bladder
botox, percutaneous sacral nerve stimulation, augmentation cytoplasty and urinary diversion
153
atrophic vaginitis arises due to
lack of oestrogen
154
diagnostic consideration in a older women presenting with recurrent UTI's, stress incontinence or pelvic organ prolapse
atrophic vaginitis
155
symptoms of atrophic vaginitis
Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation
156
management of atrophic vaginitis
topical oestrogen
157
name of the glands located either side of the posterior part of the vaginal opening
bartholin's glands
158
treatment of a bartholin's cyst
good hygiene, analgesia and warm compress
159
bartholin's abscess treatment
swab, culture and antibiotics
160
common cause of bartholin's abscess
E. Coli
161
surgical management of a bartholin's abscess
word catheter or marsupialisation
162
lichen sclerosus is a
chronic inflammatory skin condition resulting in porcelain white skin
163
typical presentation of lichen sclerosus
45-60 years complaining of vulval itching and skin changes or may be asymptomatic
164
koebner phenomenon refers too
made worse by friction
165
management of lichen sclerosus
topical steroids long term
166
the upper vagina, cervix, uterus and fallopian tubes develop from the
paramesonephric ducts (mullerian ducts)
167
what hormone suppresses the growth of the paramesonephric ducts in men?
anti-mullerian hormone
168
genetic transmission of androgen insensitivity syndrome
X-linked recessive
169
sex chromosomes of someone with androgen insensitivity
XY, however absent response to testosterone and conversion of androgens to oestrogen results in a female phenotype.
170
androgen insensitivity often presents in infancy with
inguinal hernias containing testes
171
management of androgen insensitivity syndrome
bilateral orchidectomy, oestrogen therapy, vaginal dilators
172
cervical cancers are commonly what type?
squamous cell carcinoma
173
HPV strains responsible for cervical cancer is
type 16 and 18
174
pathological mechanism of HPV causing cancer is
inhibits tumour suppressor genes
175
other than sexual activity what are other risk factors for cervical cancer
family history, HIV, full term pregnancies, COCP >5yrs, smoking
176
presentation of cervical cancer
asymptomatic, Abnormal vaginal bleeding
Vaginal discharge
Pelvic pain
Dyspareunia
177
CIN is grading for
level of dysplasia in cervix
178
CIN 1
mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
179
CIN 2
moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
180
CIN 3
severe dysplasia, very likely to progress to cancer if untreated
181
what does dyskaryosis refer to
precancerous changes
182
cervical screening regime
Every three years aged 25 – 49
| Every five years aged 50 – 64
183
HPV positive with normal cytology follow up
repeat the HPV test after 12 months
184
in colposcopy Acetic acid causes
abnormal cells to appear white
185
Schiller’s iodine test in colposcopy causes
normal cells to stain brown
186
treatment for CIN
A large loop excision of the transformation zone (LLETZ) or cone biopsy
187
risk of performing LLETZ A large loop excision of the transformation zone is
depth of tissue may increase risk of preterm labour
188
management of stage 1b-2a cervical cancer
Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
189
management of stage 2b-4a of cervical cancer
Chemotherapy and radiotherapy
190
management of stage 4b of cervical cancer
Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care
191
strain of HPV responsible for genital warts is
strain 6 and 11
192
majority of endometrial cancer is
adenocarcinoma
193
endometrial cancer is an example of what type of dependent cancers
oestrogen
194
endometrial hyperplasia may be treated with
intrauterine mirena coil or oral progestogens
195
risk factors for endometrial cancer
```
(unopposed oestrogen)
Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
type 2 diabetes
hereditary nonpolyposis colorectal cancer (HNPCC)
```
196
why is obesity a key risk factor for endometrial cancer
adipose tissue is a source of oestrogen.
also in post menopausal women aromatase in adipose converts androgens into oestrogen.
197
protective factors against endometrial cancer include
Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking
198
endometrial cancer may present with
```
post menopausal bleeding
Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
```
199
NICE recommends transvaginal ultrasound in women over 55 year with
unexplained vaginal discharge and visible haematuria
200
3 key investigations for endometrial cancer are
transvaginal ultrasound, pipelle biopsy and hysteroscopy
201
endometrial thickness less than how many mm is a negative predictor for endometrial cancer?
<4mm
202
treatment for stage 1 and 2 endometrial cancer is
total abdominal hysterectomy with bilateral salpingo-oophorectomy
203
how may progesterone be used in the treatment of endometrial cancer?
slow down progression
204
protective factors against ovarian cancer
Combined contraceptive pill
Breastfeeding
Pregnancy
205
how may an ovarian mass cause hip or groin pain?
pressing on the obturator nerve
206
refer to a 2 week wait if a physical examination reveals (gynae red flags for ovarian cancer)
```
Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass
```
207
name of a metastatic tumour in the ovary is
krukenburg tumour
208
histiological sign for a krukenberg tumour is
signet ring cells
209
significant level of Ca125 is
>35IU/mL
210
risk for malignancy index for ovarian mass being malignant takes into accord
Menopausal status
Ultrasound findings
CA125 level
211
further investigations for an ovarian mass may require
paracentesis, CT and histology
212
additional tumour cell markers for a complex ovarian mass include
A-FP and HCG
213
non malignant causes of a raised Ca-125
```
Endometriosis
Fibroids
Adenomyosis
Pelvic infection
Liver disease
Pregnancy
```
214
ovarian cancer management
MDT, surgery and chemo
215
risk factors for vulval cancer
Lichen sclerusos
216
vulval cancers are usually
squamous epithelium
217
vulval cancer frequently affects the
labia majora
218
staging and diagnosis of vulval cancer requires
biopsy, sentinel node biopsy and CT
219
management of vulval cancer requires
wide local excision, groin lymph node dissection, chemo or RT
220
bacterial vaginosis is an overgrowth of what type of bacteria?
anaerobic bacteria such as gardnerella vaginalis
221
bacterial vaginosis is due to the loss of what bacteria and what is their role?
lactobacilli and due to the production of lactic acid that lowers vaginal PH
222
what pH does anaerobic bacteria prefer the vagina to be like?
alkaline
223
risk factors of bacterial vaginosis
Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil
224
presentation of bacterial vaginosis
fishy smelling watery grey or white discharge
225
examination for BV?
speculum
226
investigations for BV?
vaginal pH, charcoal swab with micropscopy
227
BV appearance on microscopy
clue cells
228
treatment for BV is
metronidazole
229
why is metronidazole CI with alcohol
disulfram like reaction causes nausea, vomiting, flushes and even shock with angiodema
230
complications of BV in pregnancy
```
Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometriti
```
231
risk factors for vaginal candidiasis
Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics
232
presentation of vaginal candidiasis
Thick, white discharge that does not typically smell.
| Vulval and vaginal itching, irritation or discomfort
233
investigations for vaginal candiasis
PH, charcoal swab and microscopy
234
treatment for vaginal candiadiasis
single dose of intravaginal clotrimazole cream (5g) or single dose of fluconazole (150mg)
235
OTC for vaginal candiadiasis
canesten duo
236
chlamydia trachomatis is what type of bacteria
gram negative intracellular organism
237
charcoal swabs are for
microscopy and culture
238
the transport medium for charcoal swabs are
Amies transport medium
239
charcoal swabs can confirm
Bacterial vaginosis
Candidiasis
Gonorrhoeae (specifically endocervical swab)
Trichomonas vaginalis (specifically a swab from the posterior fornix)
Other bacteria, such as group B streptococcus (GBS)
240
NAAT is used for
DNA or RNAA of chlamydia or gonorrhoea
241
female presentation of chlamydia
```
asymptomatic
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)
```
242
male presentation of chlamydia
```
asymptomatic
Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis
```
243
signs of chlamydia infection on examination
```
Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
```
244
treatment for chlamydia includes
doxycycline 100mg twice a day for 7 days.
245
is doxycycline CI in pregnancy
yes
246
complications of chlamyida include
```
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
```
247
lymphogranuloma venereum refers too
lymphoid tissue around the site of infection with chlamydia
248
primary stage of LGV
painless ulcer
249
secondary stage of LGV
lymphadenitis
250
tertiary stage of LGV
inflammation of the rectum, changes in bowel habit, tenesmus and discharge
251
Tx for LGV
Doxycycline 100mg twice daily for 21 days
252
presentation of chlamydial conjunctivitis
It presents with chronic erythema, irritation and discharge lasting more than two weeks. Most cases are unilateral.
253
neisseria gonorrhoeaeis an example of
gram negative diplococcus bacteria
254
pathology of gonorrhoea
STI that infects mucuous membranes with columnar epithelium
255
female presentation of gonorrhoea
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain
256
male presentation of gonorrhoea
Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)
257
investigation of gonorrhoea
NAAT through first catch urine or swab will determine presence
Charcoal swab will determine specificity and sensitivity
258
tx of gonorrhoea
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
259
test of cure for gonorrhoea should be conducted after
72 hours after treatment for culture
7 days after treatment for RNA NATT
14 days after treatment for DNA NATT
260
complications of gonorrhoea
```
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
gonococcal conjunctivitis in a neonate
and disseminated gonococcal infection
```
261
disseminated gonococcal infection causes
Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue
262
mycoplasma genitalium is a
bacteria that causes non-gonococcal urethritis
263
investigations for mycoplasma genitalium
NAAT through vaginal swabs or first urine sample
264
management of mycoplasma genitalium is
Doxycycline 100mg twice daily for 7 days then;
| Azithromycin 1g stat then 500mg once a day for 2 days (unless it is known to be resistant to macrolides)
265
pelvic inflammatory disease is a major cause of
tubular infertility and chronic pelvic pain
266
PID may be caused by
Neisseria gonorrhoeae tends to produce more severe PID
Chlamydia trachomatis
Mycoplasma genitalium
267
presentation of PID is
```
Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding (intermenstrual or postcoital)
Pain during sex (dyspareunia)
Fever
Dysuria
```
268
examination signs of PID involve
Pelvic tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
269
investigations for PID are
HIV test, NAAT swabs and syphilis test, pregnancy test, inflammatory markers and microscopy
270
PID sign on microscopy are
pus cells
271
complications of PID are
```
Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome
```
272
fitz-hugh-curtis syndrome refers too
inflammation and infection of the liver capsule leading to adhesions
273
fitz-hugh-curtis syndrome presents with
right upper quadrant pain, shoulder tip pain
274
investigation of fitz-hugh-curtis syndrome
therapeutic laparoscopy
275
trichomonas is classified as
a protozoan
276
trichomonas increases risk of
```
Contracting HIV by damaging the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complication
```
277
symptoms of trichomonas are
Vaginal discharge (frothy and yellow-green with fishy smell)
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)
278
examination of the cervis with trichomonas reveals
a strawberry cervix
279
trichomonas investigation is with
swab, first catch urine or charcoal swab
280
management of trichomonas is with
metronidazole
281
HSV-1 remains dormant in the
trigeminal nerve ganglion
282
HSV-2 remains dormant in the
sacral nerve ganglia
283
signs and symptoms of genital herpes are
episodic:
Ulcers or blistering lesions affecting the genital area
Neuropathic type pain (tingling, burning or shooting)
Flu-like symptoms (e.g. fatigue and headaches)
Dysuria (painful urination)
Inguinal lymphadenopathy
284
diagnosis of genital herpes is through
viral PCR
285
management of genital herpes is with
aciclovir, lidocaine and topical vaseline.
286
the main issue with genital herpes during pregnancy is
neonatal herpes simplex infection
287
after an initial infection later on during pregnancy the antibodies can
confer a passive immunity via the placenta
288
primary infection before 28 weeks gestation with herpes is treated with
aciclovir
289
primary genital herpes after 28 weeks gestation is treated with
aciclovir with a recommended cesarean section
290
HIV is what type of virus
RNA retrovirus
291
aid's defining illnesses include
```
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
```
292
normal CD4 count is
500-1200
293
end stage HIV is defined as
<200 CD4
294
highly active anti retrovirus therapy medication examples
Protease inhibitors (PIs)
Integrase inhibitors (IIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Entry inhibitors (EIs)
295
what prophylaxis is given for CD4 <200 to protect against pneuocystis jirovecii pneumonia
co-trimoxazole
296
HIV tests should be done
immediately and also three months after exposure.
297
syphilis is caused by
treponema pallidum a spirochete.
298
primary syphilis involves
painless ulcer called a chancre
299
secondary syphilis involves
systemic symptoms
300
latent syphilis refers too
asymptomatic infection
301
tertiary syphilis involves
gummas, neurological and aortic aneurysms
302
secondary syphilis symptoms
```
Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions
```
303
neurosyphilis symptoms are
```
Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment
```
304
argyll-robertson pupil refers too
It is a constricted pupil that accommodates when focusing on a near object but does not react to light in neurosyphilis
305
diagnosis of syphilis is through
antibody testing (RPR, VDRL), with dark field microscopy and PCR
306
management of syphilis involves
A single deep intramuscular dose of benzathine benzylpenicillin
