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CCFP 3 > Rape, Sex, STIs > Flashcards

Rape, Sex, STIs Flashcards

1
Q

What to include in hx of rape

A

medical history, identifying info about assailant, circumstances, details of sexual contact, physical restraints/weapons/drugs, activities of victim after assault, gynae hx (LMP, contraception, pregnancy hx, last voluntary sexual encounter, gynae sx)

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2
Q

What evidence to collect after rape

A

Pt’s clothing
Fingernail scrapings
Hair strands
Oropharyngeal swabs
Pubic hair
Vaginal swabs
Vaginal washing
Pap
Rectal swab
Blood samples

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3
Q

Ix after rape + when to perform

A

Pregnancy test
VDRL (syphilis): initial visit, repeat at 12 + 24 wks
Hepatitis (if not immune, repeat at 1 + 6mo
HIV: initial visit, 6, 12 + 24wks)

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4
Q

Pregnancy prophylaxis after rape

A

Ulipristal 30mg up to 5 days
Levonorgestrel 1.5mg up to 72hrs
Copper IUD up to 7 days

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5
Q

STI prevention after rape

A

If unsure of FU, assailant has known STI, pt has sx of STI, pt requests it
Cefixime 400mg x1, azithromycin 1g x1

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6
Q

Complications + management after rape

A

Depression
Sexual dysfunction
Offer counselling to victim, family, friends, partners

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7
Q

Posthitis

A

Inflammation of foreskin

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8
Q

Phimosis

A

Narrowing of foreskin preventing retraction over glans

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9
Q

Paraphimosis

A

Narrowing of foreskin below glans preventing return to normal

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10
Q

Management congenital phimosis

A

Reassurance (a good majority can resolve spontaneously with time)
Corticosteroids (betamethasone 0.05-0.1% applied bid x 6-8 weeks with gradual retractions)
Consider Circumcision (if failure of medical treatment or concerning physical exam findings)

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11
Q

When to consider surgery in phimosis

A

Recurrent Infections
Foreskin Scarring (fibrous ring formation)
Meatal Stenosis
Excessive Ballooning with Urination
Painful Erections

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12
Q

Sx of andropause

A

Low Libido
Erectile Dysfunction
Decreased Morning Erections
Increased Body Fat
Low Muscle Mass
Decreased Physical Strength
Hair Loss
Fatigue
Low Energy
Low/Depressed Mood
Irritability
Decreased Concentration
Insomnia
Low Bone Mass
Anemia
Flushing

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13
Q

Ix for andropause

A

2x morning total testosterone serum level
FSH
LH
PRL
TSH
sHBG (sex-hormone binding globulin)
Free Testosterone
Bioavailable Testosterone

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14
Q

Meds/ substances that lower testosterone

A

Opiods
Marijuana
Ethanol
Corticosteroids
Spironolactone
Ketoconazole
Cimetidine
Neuroleptics (increases PRL)
Metoclopramide (increases PRL)
Chemotherapy

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15
Q

When to ask about sexual health and function

A

In conditions that are high risk for sexual dysfunction (post MI, diabetes)
Through life cycle transitions (adolescent, pregnant, menopause)

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16
Q

RF for ED

A

CVD: obesity, DM, dyslipidemia, metabolic syndrome, smoking
Age
OSA
Liver dz
Vit D deficiency

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17
Q

Causes of ED

A

Psychogenic: sudden acute onset, normal nocturnal + AM erections, situational
Organic: gradual onset
Vascular:
5 yrs after stroke or MI
Atherosclerosis, PVD
Substances:
Antihypertensives (BB, CCB, spironolactone)
Opiates
Antidepressants
Ranitidine
Hormones (steroids, anti-androgens)
Methotrexate
Cannabis
Cocaine
Alcohol
Psychologic: MDD, GAD, stress
Neuro:
Spinal cord injury
Polyneuropathy (DM, alcohol)
MS
Parkinsons
Alzheimers
Hormonal
Hypogonadism
Hyperprolactinemia
Thyroid
Cushings
Addisons

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18
Q

What to do on physical exam for ED

A

Peripheral pulses, BP, HR, BMI
Thyroid exam
Penis: Peyronie’s, micropenis, plaques, phimosis, frenula tether, meatal stenosis, femoral pulses
Penis sensation

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19
Q

Ix for ED

A

Lipids, a1c, TSH, ECG

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20
Q

Rx for ED

A

Counsel r.e. risk marker for CVD
Weight loss
Diet + exercise
Reduce alcohol, smoking + drugs
Meds:
PDE5i (sildenafil, tadalafil)
CI: unstable angina, uncontrolled HTN, HF, recent MI, arrhythmias, HOCM, nitrate use
SE: sudden, severe vision loss. HA, flushing, dyspepsia, congestion, visual disturbance, hypotension
Vacuum constriction device
Intracavernosal injection (alprostadil)
Surgical prosthesis

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21
Q

CI to viagra

A

Recent Myocardial Infarction
Recent Stroke
Recent Arrhythmias
Uncontrolled Hypertension/Hypotension

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22
Q

SE of viagra

A

Headaches
Flushing/Rhinitis
Abnormal Vision (blue dots)
Dizziness
Myalgia
Nausea/Dyspepsia
Priapism

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23
Q

Sx of testicular torsion

A

sudden onset, severe, unrelenting unilateral scrotal pain, N/V

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24
Q

What score to assess testicular torsion, and what Ix?

A

TWIST score
Testicular swelling (2), hard testicle (2), high riding testes (1), absent cremasteric reflex (1), N/V (1)
5/7 = positive predictive value of 100%
Doppler US

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25
Q

Management of testicular torsion

A

manual detorsion if surgery not available. Golden window is 4-8 hrs from sx onset

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26
Q

Sx fourniers gangrene

A

Groin pain
Bilateral testicular pain
Erythematous skin
SC emphysema

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27
Q

Ix fourniers gangrene

A

CT abdo

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28
Q

General prevention of STIs

A

HPV
Hep A + B
Condom use
Male circumcision
PrEP
Reduce partners

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29
Q

Screening for STIs

A

<30 + sexually active = screen annually

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30
Q

Sx acute HIV +
Sx chronic HIV

A

Sx acute HIV: flu like illness, fever, fatigue, malaise, arthralgias, HA, anorexia, rash, nightsweats, oral ulcers, pharyngitis

Sx chronic HIV: fever, fatigue, wt loss, anemia, candidiasis, SOB, cough, dysphagia, Kaposi sarcoma, HSV

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31
Q

AIDs-defining conditions

A

CMV, encephalopathy, dementia
HSV
Candidiasis, recurrent PNA, TB
Cervical cancer
Kaposi sarcoma
Lymphoma
PJP
Salmonella sepsis (recurrent)

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32
Q

Screening for HIV

A

exposure, high risk, preg, once for all 15-65

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33
Q

Pre test counselling hiv

A

Consent
Confidentiality
Counselling
Correct test results
Connect to prevention/ care/ treatment

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34
Q

Post test counselling HIV

A

Supports
HIV vs AIDs
Education re transmission
Partner notification + protection
Treatment + goals

35
Q

Ix for HIV testing

A

3w for ELISA test
If positive: HIV resistance testing, viral load, CD4

36
Q

Management of HIV: what imms to recommend, what ART regime 1st line, when to give prophylaxis against PJP + mycobacterium based on CD4 count

A

Immunisations: Hep A, B, Tdap, pneumococcal, HPV4, influenza, MMR + varicella
ART: 2 NRTI (tenofovir, entracitabine (Truvada)) + integrase inhibitor (dolutegravir)
Prophylaxis:
CD4<0.2 = Septra DS d/t risk of PJP
CD4 <0.05 = Azithromycin d/t risk of mycobacterium

37
Q

Pre-exposure prophylaxis for HIV - who and what

A

Who: MSM + condomless sex + 1) syphilis or 2) HIV positive partner not on ART OR VL >200 or 3) HIV RF >10
Tenofovir + emtricitabine

38
Q

Meds for post-exposure prophylaxis for HIV

A

Truvada + Dolutegravir x28d

39
Q

Sx of GC + CT

A

Asymptomatic - could present after exposure or partner testing positive
Sx - dysuria, urethral/ vaginal/ rectal discharge, itchy, lower abdo/ testest/ rectal pain, conjunctivitis

40
Q

Ix for CT + GC

A

first catch urine or urethral/ cervical swab NAAT - nucleic acid amplification test. Urine microscopy good for post pubertal males. Must be at least 2 days post exposure. Send for gonoccal culture to help with tracking resistance patterns

41
Q

Management of CT

A

Tx: if tests are positive or if sx are suggestive of STI or if partner was diagnosed

Treatment also for pregnant women, victims of sexual assault and those with inadequate FU
Chlamydia: doxycycline 100mg PO BID x 7 days or 1g azithromycin PO single dose if 7 day course is difficult

Lab will notify public health if result is positive

Wait 7 days after start of meds before having sex

42
Q

Management of GC

A

Tx: if tests are positive or if sx are suggestive of STI or if partner was diagnosed
Treatment also for pregnant women, victims of sexual assault and those with inadequate FU

Gonorrhea: ceftriaxone 250mg IM single dose + 1g azithromycin PO single dose, or cefixime 800mg PO single dose + 1g azithromycin PO single dose

Lab will notify public health if result is positive
Notify public health if cefixime, ceftriaxone or azithromycin FAILURE for gonoccocal infection
Wait 7 days after start of meds before having sex

43
Q

Sx of urethritis

A

Sx: 2-6d after exposure, urethral d/c/itch, dysuria, urinary freq
Abstain for 7d

44
Q

Bacterial vaginosis sx + rx

A

Sx: fishy odor, white/ grey thin d/c
Rx: metronidazole 500mg BID x 10/7

45
Q

Candidiasis sx

A

Sx: itchy, dysuria, dyspareunia, white clumpy d/c

46
Q

Trichomoniasis sx + rx

A

Sx: itchy, white/ yellow dc, strawberry cervix
Rx: metronidazole 2g x 1 dose for men, 500mg BID x7/7 for women

47
Q

Lymphogranuloma venereum sx + rx

A

Sx: painless papule, ulcers, tender inguinal nodes
Rx: doxycycline 100mg BID x 3w
Test of cure

48
Q

HSV sx + rx

A

Painful vesiculoulcerative genital lesions, systemic sx of fever, myalgias, tender lymphadenopathy
Confirm with lab testing
Partner notification not required
Rx: acyclovir 400mg TID x 10 days

49
Q

HPV sx + rx

A

Sx: cauliflower like growth
Rx: imiquimod 3.75% QHS up to 8w or cryotherapy q1-2 wks

50
Q

Chancroid sx, ix + rx

A

Sx: papules -> pustules -> painful ulcers
Ix: swab
Rx: ciprofloxacin 500mg BID x3/7
Treat partners empirically

51
Q

Pubic lice sx + rx

A

24hr life span off host
Sx: itching, erythema, small blue spots
Rx: permethrin 1% cream

52
Q

Sx + rx of scabies

A

Sx: nocturnal itching, burrows/ tracking
Rx: permethrin 5% cream + ivermectin 200ug/kg PO x1 dose
Wash clothing + bedding in hot water, vacuum mattress

53
Q

Sx of primary, secondary, latent + tertiary syphilis

A

Primary: chancre, painless ulcer with raised border, lymphadenopathy
Secondary: fever, flu like illness, rash (pink macules on palms + soles), oral lesions, genito-inguinal rash, diffuse alopecia
Latent: asymptomatic
Tertiary: aortic aneurysm, AR, HA, vertigo, dementia, ataxia

54
Q

Rx for syphilis

A

Penicillin G
FU w/ serology at 6 + 12mo

55
Q

Causes, RF + sx of epididymitis

A

Causes: CT, GC, E coli
RF: UTI, unprotected sex, catheter, reflux
Sx: testicular pain + swelling, urethritis, Phren’s sign (pain relief w/ elevation of testicle)

56
Q

Complications, dx, rx and Phren sign in epididymitis

A

Complications: testicular atrophy + infertility
Dx: STI testing, midstream urine culture
Management:
Suspected STI: doxy 100mg BID + ceftriaxone 250mg IM
Suspected enteric organism (MSM): levofloxacin 500mg x 14d
Phren sign: Scrotal elevation relieves pain in epididymitis but not in testicular torsion.

57
Q

Most common bacteria causing epidydimitis

A

E.Coli
Gram Negative Bacilli

58
Q

Sx + rx for PID

A

Sx: bilateral lower abdo pain, cervical motion tenderness
Dx: R/O ectopic
Rx: cefixime 800mg x1 + doxycycline 100mg BID x14d
Add metronidazole if adnexal mass, abscess, peritonitis or BV

59
Q

Genetic causes of infertility in males

A

Klinefelter’s, Kallmann, CF, Kartageners

60
Q

Causes of gynaecomastia

A

familial, obesity, hyperthyroidism, Klinefelter’s, Kallmann, secondary hypogonadism, hyperprolactinemia, testicular tumor, chronic renal dz

61
Q

Genetic causes of infertility in males

A

Klinefelter’s, Kallmann, CF, Kartageners

62
Q

When to urgently refer gynaecomastia

A

bloody nipple discharge, unilateral sub-areolar mass

63
Q

Causes of genital itching

A

yeast, eczema, psoriasis, lichen sclerosis, vulvar cancer, herpes, BV

64
Q

Complication of fertility treatment

A

ovarian hyperstimulation syndrome

65
Q

Non pharmacological methods of treating ED

A

penile implants, sexual counselling, vacuum devices

66
Q

Sudden penis pain after using viagra

A

priapism, penile fracture/ trauma

67
Q

How and when to test for ovarian reserves

A

anti-mullerian hormone in women >35, or <35 w/ RF: single ovary, ovarian surgery, chemo or RT

68
Q

PID rx, 1st line and if penicillin allergic

A

ceftriaxone + doxy OR clindamycin + gentamicin

69
Q

Counselling for PID

A

partner treatment, contact tracing, abstinence x1 wk

70
Q

What are the ABCs of sex?

A

Abuse, babies, cancer, STIs

71
Q

Age of consent

A

18 if exploitative, 16 if non-exploitative, age 12-13 up to 2 yrs older, age 14-15 up to 5 years older

72
Q

Priapism Ix

A

doppler US, cavernosal blood gas

73
Q

Zika virus - transmission + sx

A

spread by mosquitos or sexual, fever, HA, arthralgia, myalgia

74
Q

Types of priapism and management of each

A

non-ischemic: watch + wait, finasteride, lupron (GnRH agonist)
Ischemic: needle drainage, intracavernosal phenylephrine, surgical shunt if >48hrs

75
Q

undescended testes can increase risk of what?

A

torsion, trauma, tumors, inguinal hernias + infertility

76
Q

TWIST >6 - what to do

A

call peds uro

77
Q

Cisgender definition

A

gender identity congruent with sex assigned at birth

78
Q

Trans definition

A

individual who does not identify as cisgender

79
Q

Transgender definition

A

gender identity different to gender assigned at birth

80
Q

HIV PrEP med name

A

Truvada

81
Q

RF for ED

A

smoking, HTN, PVD, depression

82
Q

Meds that cause ED

A

H2 blockers, diuretics, BB

83
Q

Sexual minorities are at higher risk for….

A

obesity, smoking, SU, MH issues, intimate partner violence, STIs, cancer

CCFP 3 (67 decks)

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