Revision 2 Flashcards
1
Q
Can COCP be used in breastfeeding?
A
NO
UKMEC4 if breastfeeding and <6 weeks portpartum
UKMEC2 if breastfeeding and >6 weeks postpartum
2
Q
When can a copper coil or intrauterine system (e.g. Mirena) be inserted after birth?
A
Either within 48 hours after birth OR 4 weeks after birth (not in between - UKMEC 3)
3
Q
What type of condoms can be used in latex allergy?
A
Polyurethane condoms
4
Q
How long must diaphragms/cervical caps be in place following intercourse?
A
6 hours
5
Q
COCPs containing what are considered first-line for premenstrual syndrome?
Why?
A
Drospirenone –> antimineralocorticoid effects help with bloating, water retention, mood changes etc
6
Q
COCPs containing what are considered in the treatment of acne and hirsutism?
A
Cyproterone acetate (i.e. co-cyprindiol) –> anti-androgen effects
7
Q
What is potential risk in COCPs with co-cyprindiol?
A
Greater risk of VTE - only use for 3 months
8
Q
Risk of which cancers are REDUCED with the COCP?
A
Ovarian, endometrial & colon
9
Q
Risk of which cancers are INCREASED with the COCP?
A
Breast and cervical
10
Q
What UKMEC is a BMI > 35 for the COCP?
A
UKMEC 3
11
Q
Starting the COCP on what day of the cycle offers protection straight away?
A
Day 1-5
12
Q
COCP and major operations?
A
Should be stopped 4 weeks before
13
Q
What is the only UKMEC 4 criteria for POP?
A
Active breast cancer
14
Q
What must be excluded where irregular bleeding is persistent >3 months after starting the POP?
A
STIs, pregnancy or cancer.
15
Q
How often is the contraceptive injection given?
A
Every 12w (3m)
16
Q
Why is the progesterone only injection less suitable for women wishing to great pregnant in the near term?
A
Can take up to 12m for fertility to return
17
Q
What is a potential long term complication of DMPA?
A
Osteoporosis
18
Q
What is the main mechanism of action of the progesterone injection?
A
Inhibits ovulation
19
Q
What 2 side effects are unique to the progesterone only injection?
A
1) weight gain
2) osteoporosis
20
Q
Between what ages is Nexpanon (implant) licensed for use?
A
18 and 40 y/o
21
Q
What is the most effective form of contraception available?
A
Implant
22
Q
What guidelines are used for providing contraception to patients under 16 years without having parental input and consent?
A
Fraser guidelines
23
Q
To follow the Frazer guidelines, what 5 critiera must the patient meet?
A
1) Mature and intelligent enough to understand treatment
2) Can’t be persuaded to discuss with their parents, or let the health professional discuss it
3) Likely to have intercourse regardless of treatment
4) Their physical or mental health is likely to suffer without treatment
5) Treatment is in best interest
24
Q
What hormone does the intrauterine system (IUS) contain?
A
Levonorgestrel (form of progesterone)
25
How long is the Mirena coil licensed for in
a) HRT
b) contraception
a) 5 years
b) 6 years
26
When the coil threads cannot be seen or palpated, what 1st line investigation is required?
US
27
After female sterilisation, how long is alternative contraception required?
Until the next menstrual period - as an ovum may have already reached the uterus during that cycle, ready for fertilisation.
28
What is involved in a vasectomy?
This involves cutting the vas deferens, preventing sperm travelling from the testes to join the ejaculated fluid. This prevents sperm from being released into the vagina, preventing pregnancy.
29
After male sterilisation, how long is alternative contraception required?
What is required before a vasectomy can be relied upon for contraception?
2 months after
Testing of the semen to confirm the absence of sperm is necessary before it can be relied upon for contraception.
Semen testing is usually carried out around 12 weeks after the procedure, as it takes time for sperm that are still in the tubes to be cleared. A second semen analysis may be required for confirmation.
30
How long after taking EllaOne (ulipristal acetate) must you wait before taking COCP/POP?
5 days
31
What are the 2 major contraindications with ulipristal acetate?
1) breastfeeding
2) severe asthma
32
How long should breastfeeding be avoided after taking ulipristal acetate?
1 week - milk should be expressed and discarded
33
How soon after unprotected sex should the copper coil be inserted?
5 days within UPSI or up to 5 days after estimated date of ovulation
34
What dose of levonorgestrel is given as emergency contraception?
1.5mg single dose (3mg if BMI >26)
35
Mx of all patients with 2ary dysmenorrhoea?
Refer to gynae for further investigations
36
What is offered 1st line in the mx of dysmenorrhoea?
NSAIDs - inhibit prostaglandin synthesis (one of the main causes of dysmenorrhoea)
37
When is cervical ectropion more common?
- during pregnancy
- on COCP
38
How long after fitting a Mirena coil does it take to become effective?
7 days
39
Stepwise mx of PMS?
1) Lifestyle e.g. sleep, exercise, smoking, alcohol, regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates
2) COCP (w/ drospirenone)
3) SSRI (severe symptoms) - can be taken continuously or just during luteal phase)
40
What contraceptive methods are indicated in transgender men (assigned female at birth) who are undergoing testosterone therapy?
IUD or barrier (no hormones as would interact with testosterone)
41
What type of bacteria is chlamydia trachomatis?
Gram negative obligate intracellular bacteria
42
How can chlamydia present in a newborn? (2)
1) Pneumonia
2) Neonatal conjunctivitis (ophthalmia neonatorum)
43
What 2 types of swabs are used in sexual health testing?
1) Charcoal swabs
2) Nucleic acid amplification test (NAAT) swabs
44
What is NAAT testing used to test specifically for?
(2)
1) Chlamydia
2) Gonorrhoea
45
In women, a NAAT can be performed on what 3 methods of sample collecting?
1) Vulvovaginal swab (a self-taken lower vaginal swab)
2) Endocervical swab
3) First-catch urine sample
The order of preference is endocervical, vulvovaginal, and then urine.
46
If gonorrhoea is suspected or demonstrated on a NAAT test, what happens next?
An endocervical charcoal swab is required for microscopy, culture and sensitivities.
47
1st line management for uncomplicated chlamydia?
Doxycycline (oral) 100mg 2x a day for 7 days
48
Contraindications for doxycycline in treatment of chlamydia?
(2)
1) Pregnancy
2) Breastfeeding
49
Alternatives options for doxycycline in treatment of chlamydia incases of pregnancy/breastfeeding?
Macrolides e.g. erythromycin
50
When is a test of cure recommended for chlamydia?
(3)
1) rectal cases
2) in pregancy
3) symptoms persist
51
What is Lymphogranuloma venereum (LGV)?
A condition affecting the lymphoid tissue around the site of infection with chlamydia.
Caused by a serotype of Chlamydia trachomatis.
52
Who does LGV most commonly present in?
MSM presenting with anal discharge and pain, or anyone presenting with rectal chlamydia.
53
Management of LGV?
Requires longer (21 days) course of Abx
54
What is a crucial differential diagnosis of Chlamydial Conjunctivitis and should always be tested?
Gonococcal conjunctivitis –> can result in severe complications such as vision loss if the bacteria penetrate further and cause corneal ulceration and scarring
55
What type of bacteria is Neisseria gonorrhoeae?
Gram -ve diplococcus
56
Why should a standard charcoal endocervical swab also be taken from the symptomatic area in all patients with symptoms of gonorrhoea?
This is to test for sensitivities and monitor patterns of antimicrobial resistance.
NAAT just tests for the presence of the bacteria.
57
1st line management for gonorrhoea?
IM injection 1g ceftriaxone
58
what class of antibiotic is ceftriaxone?
cephalosporin
59
what class of antibiotic is cirpofloxacin?
fluoroquinolone
60
Why should ALL patients with gonorrhoea have a follow up ‘test of cure’ 2 weeks after treatment?
given the high abx resistance
61
Causative organism of syphilis?
Treponema pallidum
62
What is the incubation period of syphilis (i.e. time from inital infection to symptom presentation)?
Approx 21 days
63
What type of bacteria is Treponema pallidum?
Spirochete
64
Congenital syphilis (i.e., present from birth) can be broken down into two stages.
What are these?
Early congenital --> presents in those <2 y/o
Late congential --> presents in those >2 y/o
65
How does PRIMARY syphilis present?
Development of an indurated painless ulcer (chancre) on the genitals.
66
How does secondary syphilis typically present?
Widespread non-pruritic maculopapular rash (if involving the soles and palms, is almost pathognomonic for syphilis)
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions
67
What rash is almost pathognomonic for syphilis?
Widespread non-pruritic maculopapular rash involving palms and soles
68
When does tertiary syphilis occur?
occurs >2 years following infection
69
Features of 3ary syphilis?
- Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
- Aortic aneurysms
- Neurosyphilis
70
What is Argyll-Robertson pupil? What is it found in?
A specific finding in neurosyphilis.
It is a constricted pupil that accommodates when focusing on a near object but does not react to light.
They are often irregularly shaped.
71
What is the mainstay of diagnosis of syphilis?
Serology
72
In patients with lesions, how can syphilis be diagnosed?
syphilis PCR swab of the lesion
73
What is the window period of syphilis?
12 weeks
Testing should be repeated at least 12 weeks after last exposure
74
1st line pharmacological management of syphilis?
Single deep IM dose of benzathine benzylpenicillin
75
What is a Jarisch-Herxheimer reaction?
A Jarisch-Herxheimer (JH) reaction can occur following the initial treatment of syphilis in some patients.
This phenomenon causes a sepsis-like picture due to the release of toxins from treponemal bacterium breakdown.
76
Which sensory nerve ganglia is affected in genital herpes?
Sacral nerve ganglia
77
How should a PCR swab of HSV lesion be taken?
The lesion should be BURST and a swab taken from the BASE of the ulcer.
Lesions must be present for HSV testing to occur.
78
When is the risk of neonatal HSV increased?
If mother becomes infected in 3rd trimester
79
What should be excluded if genital wart lesions appear atypical or suspicious?
Oncogenic HPV type
80
What risk factor is known to increase the risk of genital wart recurrence?
Smoking
81
Topical treatments for genital warts?
1) Topical podophyllotoxin (Warticon® and Condyline®)
2) Topical imiquimod (patients should be made aware that this damages condoms)
82
What are some physical ablation therapy options for genital warts?
1) Cryotherapy
2) Surgical excision
83
What is trichomoniasis?
STI caused by a parasite/protozoan - (Trichomonas vaginalis)
84
How is vaginal discharge typically described in trichomoniasis?
Frothy and yellow-green, although this can vary significantly. It may have a fishy smell.
85
What can examination of the cervix in trichomoniasis reveal?
Strawberry cervix
86
Vaginal pH in trichomoniasis?
Raised pH (>4.5)
87
Where should swabs for trichomoniasis be taken from in women?
Posterior fornix of vagina (behind cervix)
88
Management of trichomoniasis?
Metronidazole
89
How long should alcohol be avoided for following treatment with metronidazole?
72h
90
What bacteria can cause non-gonococcal urethritis?
Mycoplasma genitalium
91
what is the gold standard for diagnosis of mycoplasma genitalium?
NAAT
92
1st line management of uncomplicated Mycoplasma genitalium?
1) Doxycycline 100mg twice daily for 7 days
2) Followed by azithromycin 1g as a single dose then 500mg daily for 2 days
93
What human cells does HIV infect?
CD4+ helper cells
94
What are the 2 types of HIV?
HIV-1 (most common)
HIV-2 (mainly found in west africa)
95
What is the protein on the surface of HIV that binds to CD4+?
gp120
96
What CD4+ cell countis sufficient for a diagnosis of AIDS?
<200
97
Give some examples of AIDS-deining illnesses
1) Kaposi's sarcoma
2) PCP
3) CMV infection
4) Candidiasis
5) Lymphomas
6) TB
7) Hairy leukplakia
98
What is the treatment aim of ART in HIV? (2)
1) undetectable viral load
2) normal CD4+ count
99
When must PEP be commenced after HIV exposure?
within 72h
100
What is the most common life-threatening opportunistic infection in AIDS?
Pneumonia
101
Which mode of delivery is used in mothers with the following HIV viral loads:
a) under 50 copies/ml
b) over 50 copies/ml
c) over 400 copies/ml
a) vaginal
b) consider a pre-labour c-section
c) pre-labour c-section is recommended
102
What is given as an infusion during labour and delivery if the HIV viral load is unknown or above 1000 copies/ml?
IV zidovudine
103
when is IV zidovudine given during labour and delivery?
if viral load is unknown or >1000
104
Can HIV be transmitted during breastfeeding?
Yes
ALWAYS avoid breastfeeding
105
Investigation window period for chlamydia?
2 weeks
106
When is a test of cure for gonorrhoea recommended?
Pregnancy
107
Discharge in men in gonorrhoea vs chlamydia?
Gonorrhoea - urethritis +/- yellow discharge
Chlamydia - urethral discharge typically clear/white
108
What are the 2 most common causes of non-gonococcal urethritis?
1) Chlamydia trachomatis
2) Mycoplasma genitalium
109
Does urethral discharge always need investigation?
Yes
110
What symptom typically accompanies a chancre?
Local lymphadenopathy
111
Management of late latent, CVS and gummatous syphilis?
Benzathine penicillin IM for 3 weeks
112
Length of aciclovir treatment in herpes in primary vs recurrent infection?
Primary - 10 days
Recurrent - 3 days
113
What systemic symptoms can initial infection with herpes cause?
- dysuria
- myalgia
- flu like
- fever
- malaise
114
What triad is seen in disseminated gonococcal infection?
1) tenosynovitis
2) migratory polyarthritis
3) dermatitis
115
What investigation is standard for diagnosis and screening of HIV?
Combination HIV p24 antigen and HIV antibody test
116
What is acute epididymo-orchitis in sexually active younger adults most commonly caused by?
Chlamydia
117
Investigation of choice in genital herpes?
NAAT tests
118
What determines the risk of HIV transmission following a needle stick injury?
Viral load (higher load = higher risk)
119
mx of genital warts:
1) multiple, non-keratinised warts
2) solitary, keratinised warts
1) topical podophyllum
2) cryotherapy
120
What is the most common and important viral infection in solid organ transplant recipients?
CMV
121
Most common cause of epididymo-orchitis in individuals with a low STI risk (e.g. married male in 50s, wife only partner)?
E. coli (enteric organisms)
122
Mx of herpes if contracted during 3rd term?
Oral aciclovir 400 mg TDS (three times daily) until delivery
IV aciclovir for the mother or for the infant is only recommended if there has been a PPROM or a spontaneous vaginal delivery in the presence of a 1ary herpes infection.
123
Which type of pneumonia typically causes desaturation on exertion and a normal CXR?
PCP
124
What is the component of the healthy vaginal bacterial flora?
Lactobacilli (produce lactic acid --> keep pH low)
125
What is the ideal pH of the vaginal canal?
3.8 - 4.5
126
What anaerobic bacteria causes BV?
Gardnerella vaginalis
127
At what vaginal pH does BV occur?
>4.5
128
What is the most likely cause of discharge changes in post-menopausal women?
Atrophic vaginitis (reduction in oestrogen causes irritation)
129
Describe discharge & odour in
a) BV
b) Candida
c) Trichomonias vaginalis
a) thin & watery, fishy
b) thick & white, no odour
c) green & frothy, fishy
130
Describe vulval irritation in
a) BV
b) Candida
c) Trichomonias vaginalis
a) nil
b) itching, irritation & pain
c) itching, soreness & dysuria
131
Describe vaginal pH in
a) BV
b) Candida
c) Trichomonias vaginalis
d) Physiological
a) >4.5
b) <4.5
c) >4.5
d) <4.5
132
What is seen on microscopy in BV?
'Clue cells' - epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.
133
A diagnosis of BV can be made based on bedside investigations using what 2 criteria?
1) Amsel criteria
2) Hay/Ison criteria
134
What are the Amsel criteria?
1) Homogeneous discharge on clinical examination
2) Microscopy showing clue cells
3) Fishy odour on adding 10% potassium hydroxide to vaginal fluid
4) Vaginal pH >4.5
135
What is the Abx of choice in treating BV?
Metronidazole (specifically targets anaerobic bacteria)
136
Complications of BV?
Higher risk of STIs
137
what hormonal changes can increase risk of candidiasis?
Increased oestrogen e.g. pregnancy
138
What antifungal agent is present in topical antifungal creams & vaginal pessaries for candidiasis?
Clotrimazole
139
What antifungal agent is present in oral medications for candidiasis?
Fluconazole
140
Contraindications of oral antifungal tablets for candidiasis?
pregnant women, women at risk of pregnancy, and breastfeeding women.
141
What is Fitz-Hugh-Curtis Syndrome?
A complication of PID (10%).
Caused by inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum.
Presentation --> RUQ pain that can be referred to the right shoulder tip if there is diaphragmatic irritation.
142
What may Fitz-Hugh-Curtis Syndrome be confused with?
Cholecystitis
143
When are antibiotics started in PID?
Empirically
144
A typical outpatient regime for PID:
Combination of:
1) Doxycycline
2) Metronidazole
3) Ceftriaxone
145
What should you always look for signs of in PID?
Sepsis !
146
In which cases of PID require admission for IV Abx?
1) sepsis
2) pregnancy
147
1st line for mx of non-pregnant women with thrush?
Single dose of oral fluconazole
148
Mx of BV in pregnant women?
Oral metronidazole (low dose) for 7 days
149
What is chancroid?
A tropical disease caused by Haemophilus ducreyi.
It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement.
150
Features of chancroid?
- painful genital ulcers
- unilateral inguinal lymph node enlargement
- ulcers have sharply defined, ragged, undermined border
151
When should a positive HIV test be repeated?
Around 12 weeks time
Start antiretroviral therapy in the meantime
152
