O&G Sexual Health Flashcards

Question

Management of hyperemesis gravidarum

Answer 1

Small frequent fluids and food (high carb low fat), avoid hunger Lie down if dizzy Avoid smells and triggers Acupressure Mild - No dehydration - PO antiemetic - oral rehydration Moderate - Dehydration (dizziness, dry MM, slow cap refill, postural drop, sunken eyes, slow skin turgor, tachycardia, hypotension) - Ketones >+2 - Community IVF and antiemetics Severe - >5% weight loss, biochemical abnormalities - Community +/- hospital IVF and antiemetic - Dietician referral - Thiamine + omeprazole Antiemetics of choice - cyclizine, metoclopramide, prochlorperazine, promethanzine, ondansetron

Answer 2

Molar pregnancy Multiple pregnancy Primiparous Young Non-smoker Chronic H. pylori Pasifika

Answer 3

>20 weeks gestation New onset hypertension Mild - 140-159 systolic, 90-109 diastolic Severe >160 systolic, >110 diastolic Plus one of: - Proteinuria +/- oedema - Organ dysfunction - Neuro (hyperreflexia, clonus, visual scotoma) - Haem (low platelets, haemolytic) - Renal impairment - Deranged LFTs - Uteroplacental dysfunction (growth restriction, abruption) HELLP - pre-eclampsia variant Haemolysis Elevated LFTs Low platelets

Answer 4

Seizure in pregnant patient with or without pre-eclampsia 60-90s duration, self-limiting 53% antepartum 19% intrapartum 28% 48 hrs postpartum Late post-partum = >2 weeks

Answer 5

Major: - Antiphospholipid abs - SLE - Hx pre-eclampsia - self, mother, sister - Pre-existing HTN - Diabetes, renal disease Minor: - Oocyte donation - African, Indian, Maori, Pacific - Primiparous, pregnancy interval >10 years - Multiple pregnancies - Hx pre-eclampsia in paternal family - Change in partner, sperm donor - BMI >35 - Age >40

Answer 6

Urgent obstetrics referral Antihypertensives - labetalol, nifedipine, hydralazine Target BP 130-150/80-100 MgSO4 Aspirin and calcium to women at high risk of pre-eclampsia

Answer 7

Levonorgestrel 1.5mg stat 3mg stat BMI >26 or >70kg Within 72 hours of UPSI (ideally 12hrs) Contraindications: clots, breast ca, IBD, porphyria, active trophoblastic disease Reduced efficacy within 28 days liver enzyme inducing meds - barbiturates, anti epileptics, rifampicin

Answer 8

BMI >26 more effective Only option for BMI >30 Insert within 5 days of ovulation or within 120 hours of UPSI May worsening heavy menstrual bleed or menorrhagia

Answer 9

1. Urethral swab 2. First void urine - no PU within 1 hour, do not clean first, take first 30mL 3. Consider MSU for cystitis 4. Consider herpes swab Send for chlamydia + gonorrhoea NAAT

Answer 10

<30 years Sexually active Recent change in sexual partner Multiple sexual partners Prev STI Post partum Post TOP Post instrumentation

Answer 11

Tubo-ovarian abscess Chronic pain Ectopic pregnancy Tubal factor infertility Fitz-Hugh-Curtis syndrome - peri hepatitis

Answer 12

Usually ascending chlamydia, gonorrhoea infection Ceftriaxone 500mg IM with 2mL lignocaine 1% Doxycycline 100mg BD 14 days Metronidazole 400mg BD 14 days Leave IUD in, don't remove until on abx for >24 hours Contact trace and treat for chlamydia all partners of last 3/12 No sex until pain resolves Condoms for 14 days after treatment and 7 days after treatment of sexual contacts Repeat STI check in 3/12

Answer 13

HSV 1 - mostly facial lesions. 30-40% genital herpes HSV 2 - 60-70% genital herpes 20% adults have asymptomatic HSV 2

Answer 14

Flu-like illness Painful ulcers, vesicular rash in groin, perineum, genitals, mucosa - lasts 2-3 weeks if untreated Tender local lymphadenopathy Dysuria and difficulty passing urine in women Reactivation: Smaller lesions, more closely grouped Lasts 5-10 days No flu-like prodrome

Answer 15

Skin to skin transmission Viral shedding 100-1000 times greater in active episode Unlikely fomites - virus dies at room temperature Lifelong infection - latent in ganglia of sensory nerves Reactivation and recurrence - Minor trauma - Other infection - UV radiation - Menstrual - Emotional stress

Answer 16

Valaciclovir 500mg BD 7 days Immunocompromised: 1g BD 7-10 days Salt wash Lignocaine Increase fluids, urinate in shower Avoid sex Refer if herpes proctitis, neonates, pregnant Recurrence: Valaciclovir 500mg BD 3 days Prophylaxis for frequent recurrence: Valaciclovir 500mg OD or Acyclovir 400mg BD No increased risk of ca Not indicative of partner cheating

Answer 17

90% caused by HPV 6, 11 Can appear 3-6 months after skin-skin contact Flesh coloured papule, may join together to form plaques Pain Bleeding Itch

Answer 18

Podophyllotoxin 5mg/mL apply BD for 3 consecutive days/week for 5 weeks Imiquimod 3 alternate days/week for 16 weeks Cryotherapy - only option in pregnancy Laser Hyfrecation Surgical excision Refer: - Children if NAI concerns, cervical warts, intraurethral, extensive, pregnancy, immunosuppression, diabetes, HIV, ?malignancy

Answer 19

50% asymptomatic 10-90 days incubation Solitary genital/anal/mouth ulcer, usually painless - 30% multiple lesions - Resolves spontaneously

Answer 20

Treponema pallidum Contact with mucocutaneous skin Vertical transmission - congenital syphilis

Answer 21

Sexually active Contact of syphilis case MSM Routine checks - sexual health - pregnancy - immigration

Answer 22

Incubation time 2-24 weeks 90% involving skin: - rash on palms or soles - generalised body rash - Atypical mouth ulcer - condylomata lata - patchy alopecia Constitutional: Fever, lethargy, lymphadenopathy Neuro: ocular nerve palsy, unilateral deafness, meningitis

Answer 23

Atypical neuro - paraesthesia, ataxia, dementia, deafness, visual impairment Cardiovascular disease - aortitis Gummata - inflammatory nodules on skin/bone

Answer 24

Contact tracing Referral to sexual health - do not start treatment without advice (usually benazathine penicillin) Abstain from sex until treatment complete Notify MOH

Answer 25

<30 years sexual contact of gonorrhoea Recent gonorrhoea Multiple sexual contacts MSM Coexisting STI - HIV, chlamydia Inconsistent condom use Anal, oral sex Drug use Commercial sex work

Answer 26

Symptomatic in 95% men and 50% women Purulent discharge, dysuria, abdo pain Men: scrotal pain, anal pain/pruritis/bleeding Women: abnormal bleeding, dyspareunia, rectal infections often asymptomatic 90% pharyngeal infections asymptomatic

Answer 27

Ceftriaxone 500mg IM Azithromycin 1g stat If rectal chlamydia - add doxycycline 100mg BD 7 days Abstain or condoms for 1 week after treatment and treatment of contacts Contact trace 2 months Notify MOH Follow up 7 days

Answer 28

Age <25 Sexual contact with chlamydia 2+ sexual partners in last year Recent change in sexual partner Inconsistent condom Co-infection with another STI

Answer 29

Asymptomatic in 50% men, 70% women Men: urethritis (dysuria, discharge), epididymo-orchitis (unilateral testicular pain, swelling) Women: Dysuria, vaginal discharge, intermenstrual/post coital bleeding, deep dyspareunia, lower abdo pain, fever Cervix - friable, "cobblestone" appearance, contact bleed Rectal chlamydia - asymptomatic in 70% MSM, 90% women. Proctitis + mucopurulent discharge

Answer 30

1st line: doxycycline 100mg BD 7 days (97% effective) - More effective in rectal chlamydia 2nd line: azithromycin 1g stat (94% effective) - Emerging resistance in other STIs Abstain or condoms for 7 days post treatment of self and contacts Contact trace 2 months Follow up in 7 days

Answer 31

Vulvovaginal swab for chlamydia, gonorrhoea, +/- trichomoniasis (Maori, Pacific, low SES, incarceration, contact) HIV and syphilis serology Consider: Speculum + bimanual if symptomatic High vaginal swab - BV, candida Endocervical swab for gonorrhoea Anorectal, pharyngeal swabs Hep B, C serology

Answer 32

First pass urine for chlamydia, gonorrhoea HIV, syphilis serology Consider: Urethral swab for gonorrhoea if discharge Pharyngeal/anorectal NAAT swabs if MSM Herpes swab if ulceration Hep B, C serology Hep A serology if MSM

O&G Sexual Health Flashcards

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