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Flashcards in Week 2 Deck (345):
1

How many kids are born every 2 seconds

9

2

How many deaths per 2 seconds

3

3

What is the Basal Body temp increase during ovulation

>0.2 C

4

What is the position of the cervix when a woman is fertile

High in vagina, soft and open

5

What is the position of the cervix when a woman is less fertile

Low in vagina, firm and closed

6

When is a woman most fertile in a normal 28 day cycle

Days 8-18 (7 days before ovulation and 3 days after)

7

3 criteria for breastfeeding to be an effective contraceptive

1- Exclusively breast feeding
2- Less than 6/12 post natal
3- Amenorrhoeic

8

UKMEC stands for

UK Medical Eligibility Criteria

9

What are the four categories of contraceptive methods in the UK MEC

1- No restrictions
2- Advantages outweigh risks
3- Risks outweigh advantages
4- Unacceptable risks

Patient to Patient basis

10

Assessment of patient before prescribing contraception

Medical conditions( past and present)
FH (past and present)
DH
Drug interactions
Recheck anually

11

What is the Pearl Index

No. or contraceptive failures per 100 women users/year

12

What does LARC and VLARC stand for

Long Acting Reversible Contraception
Very Long Acting Reversible Contraception

13

Examples of LARC

Injectable Contraceptive
UK= Depo Provera

14

Examples of VLARC

Intra Uterine Device
Intra Uterine System
Implant

15

What does IUD and IUS stand for

Intra Uterine Device
Intra Uterine System

16

What is the primary action of Depo Provera

Inhibits ovulation

17

What are other effects of Depo Provera
Other than ovulation inhibition

Effect on cervical musus
Effect on endometrium

18

What examinations should be done prior to Depo Provera administration

BP and BMI record
Smear status
Consider risk factors for Osteoporosis

19

Contraindications to Depo Provera
(Not Chronic conditions)

Underweight -- Anorexia -- Steroid use -- Excess EtOH -- Immobility -- FH -- Smoking -- Low trauma fractures

20

Contraindications to Depo Provera (Chronic conditions)

Hypothyroidism -- Celiac disease -- RA -- Hyperparathyroidism -- IBD -- Chronic renal disease

21

When should Depo Provera be started without the need for any additonal contraception

Up to and including day 5 of the cycle

22

Side effects of Depo Provera

- Weight Gain
- Delay in return of fertility (6-9 month average)
- Irregular bleeding
- Increased risk of Osteoporosis

23

What is the active component of an IUD

Copper

24

What are IUDs made of. 2 component plus additional compnent

Copper and Plastic
May contain silver or a noble metal to prevent corosion

25

What is the primary mode of action of an IUD

Prevent fertilisation

26

How long does a IUD last?

License for 5 or 10 years

27

What is most effective, IUD or Depo

Depo, Pearl index 0.3%
IUD has Pearl Index of 0.5%

28

What is an IUS

Intra uterine system
T shaped device with elastomere core

29

What is the active in IUS

Levonorgestrel

30

What is the primary mode of action of an IUS

Effect on Implantation
The endometrium is rendered unfavorable for implantation

31

What is most effective, Depo or IUS

IUS - Pearl index 0.2
Depo - Pearl index 0.3

32

Contraindications of IUD/IUS

- Current Pelvic infection, incl STI's
- Abnormal Uterine anatomy (septum etc)
- Pregnancy
- Endometrial or Cervical Cancer

33

Examination prior to IUS/IUD administration

Bimanual vaginal examination (PV)
BP and pulse

34

When can an IUD be fitted

-Within first 7 days of a period
-Not pregnant
-5 days after UPSI (for EC)
- Within 48hrs or >4 weeks post partum
-Immediately post TOP

35

When can an IUS be fitted

- Within first 7 days of period
- If fitted outside 7/7, use condoms for 7/7
- NOT used for EC
-Within 48hrs or >4weeks post partum
-Immediately post TOP

36

Side effects of IUD

- Heavy, prolonged menses
- Pain, infection
-Perforation 1/1000
-Risk of Ectopic pregnancy higher??

37

What are the two types of IUS

- 52mg Levonorgestrel (5yr license)
- 13.5mg Levornorgestrel (3yr license)

38

Side effects of IUS

-Lighter, less frequent bleed
-Pain, infection
-Perforation 1/1000
-Ectopic pregnancy risk higher??
-Failure (Pregnancy)

39

What is a Contraceptive Implant

Single-rod, etonogestrel-releasing, subdermal implant

40

What is the level of Etonogestrel released by a Contraceptive Implant

60-70ug per day initially
25-30 ug per day at end of three years

41

Primary mode of action of Contraceptive Implant

Inhibition of ovulation

42

What is most effective, Implant or IUS

Implant - Pearl rate 0-0.1%
IUS - Pearl rate 0.2%

43

When is an Implant fitted

First 5 days of cycle
On or before day 21 post partum
No additional precautions during this time

44

Side effects of Implant

Irregular bleeding
Weight gain
Acne
-Deep insertion
-Nerve/Vasular damage

45

What does CHC stand for

Combined Hormonal Contraception

46

What does POP stand for

Progestrogen Only Pill

47

What does EHC stand for

Emergency Hormonal Contraception

48

Why do pts choose Short acting methods of contraception

- Compliance and Concordance
-Control
-Short term
- Non-contraceptive benefits
-Personal reasoning

49

What are some examples of Non-Contraceptive benefits of CHC that might minimize

-Heavy menstrual bleedings
-Painful periods
-Acne
-Irregular periods
-Premenstrual symptoms
-Endometriosis
-Menstrual migraine

50

What are the three types of CHC available

COC - Combined oral Contraceptive pill
CTP - Combined transdermal patch
CVR - Combined Vaginal Ring

51

What is the Efficacy of CHC's

Perfect use - 0.3%
Typical - 9%

52

Name a reason CTP would not work

If the pt weights over 90kg

53

Primary mode of action of CHC

Inhibits ovulation via action on the hypothalmic-pituitary-ovarian axis to reduce luteinizing and follicle-stimulating hormones

54

What is the secondary mode of action pf CHC

-Alters cervical mucous
-Renders endometrium unfavorable for implantation

55

What is the standard regime for COC

Take daily for 21 days and then stop for 7 days

56

What happens during the 7 day break of COC

Withdrawal belled occurs due to shedding of the endometrium (Not menstruation)

57

What is the name of a common COC

Rigevidon

58

What is the standard regime for CTP

One patch a week for 3 weeks. 1 patch free week with withdrawal bleeding

59

What does CVR stand for

Combined Vaginal Ring

60

What is the regime of CVR

One ring is placed into the vagina and left for 21 days.
7 days ring free to induce withdrawal bleed and then repeat with new ring

61

What does EE stand for

Ethinyl Estradiol

62

What does EE alternate (non contraceptive side effect)

Clotting factor
Reduces Antithrombin III and Protein S
Increase risk of thrombosis

63

What are the risks of CHC

-Venous thrombosis
-Arterial thrombosis
-Adverse effects on some cancers

64

COC effect on BP

Slight increase

65

What are risk factors for VTE that must be accounted for when perscribing COC

-Obesity
-Smoking
-Age
-Known Thrombophilia
-VTE in first degree relative 4500m altitude
-Long-haul flights
-Reduced mobility
-Anti-phospholipid syndrome
-Other conditons causing increased VTE risk

66

What is Cyproterone Acetate used for

Acne and hirsutism treatment

67

Should hypertensive patients >160/>95 or patients with migraine with aura be prescribed COC

There is an increased risk of CVA or MI so in some cases not

68

What examinations should be done prior to prescribing COC

Record BP and BMI
Smear status
Check multiple risk factors - UKMEC

69

What cancers does CHC protect against

Ovarian cancer (20% reduction in first 5 years, 50% after 15years)
Endometrial cancer (50%)

70

What is the effect of CHC on Acne

Beneficial

71

If a pt experience unscheduled bleeding while just started new CHC. What should be done?

Nothing until 3 months. Most bleed settles with time

72

Side effects of CHC

-Unscheduled bleed
-Mood changes
-Weight gain

73

When should CHC be started

Within 5 days of start of cycle without additional contraception

74

What is Levonelle

After Emergency Contraception

75

What is the acting ingredient in Levonelle

Progestogen

76

What are the instructions after taking Levonelle

Abstain/Condoms for 7 days

77

Examples of After Emergency Contraception

Levonelle
Ella (EllaOne) - Ulipristal Acetate

78

What is the advice after taking Ella (Ulipristal Acetate)

Avoid starting contraception for 5 days

79

If you miss a pill, what should one do?

-Over 24 hours and less than 48 hours
-Take the missed pill as soon as it is remembered
-Remaining pills are taken at the normal time
-EC is not required

80

If you miss two or more pills, More than 48 hrs without pills. What should one do

-Take the most recent missed pill
-Take the remaining pills at the correct time
-Use condoms or abstain until 7 pills have been taken consecutively

81

Minimize risk of Pregnancy if more than 48h without pills

Days 1-7: Consider EC
Days 8-14: No extra instructions
Days 15-21: Omit pill free interval

82

Transvaginal ring can be left out of vagina for how long before efficacy is reduced

48h

83

How long can a vaginal ring be worn without efficacy is reduced

4 weeks

84

What type of Progesterone only pills are there?

Levonorgestrel
Norethisterone
Etonorgestrel - Longer acting

85

Primary Mode of Action of Progesterone only pills

Thickening of cervical mucus
Etonorgestrel suppresses ovulation in up to 97% of cycles

86

Secondary Mode of action of Progesterone only pills

Levonorgestrel suppre ovulation in 60% of cycles
Reduced endometrial receptivity to blastocyst
Reduced cilia activity in fallopian tube

87

What is the window of forgivness with Levonorgestrel and Norethisterone (older pills)

Within 24-27h of last dose
window is three hours

88

What is the window of forgiveness with Etonorgestrel (Long acting POP)

Within 24-36h of last dose
Window is 12h

89

What is the perfect use vs typical use efficacy of POP

0.3% vs 9%

90

IUD stands for

Intra uterine Device

91

IUS stands for

Intrauterine System

92

UPSI stands for

Unprotected Sexual intercourse

93

What are the options for emergency Contraception

Oral
-Levonelle
-Ella (EllaOne)
Intrauterine
-Copper IUD

94

What is the active ingredient in Ella (ellaOne)

Ulipristal acetate

95

What is the active ingredient in Levonelle

Levonorgestrel

96

How long after UPSI can Levonelle be taken

Up to 72h

97

How long after UPSI can Ella (ellaOne) be taken

Up to 120 hours

98

How long post-UPSI can an Copper IUD be inserted

up to 120 hours

99

What is the highest age group for termination of pregnancy

20-24

100

How many grounds for termination are there

5 non-emergency
2 emergency

101

Up until what week can a non-emergency termination be done

24th week

102

What are the two methods of termination

Medical
Surgical

103

When can medical Termination of Pregnancy be done

18week+6days in NW
Can be done until 24week

104

What type of surgical methods for termination of pregnancy are there

Vaccum aspiration
Dilatation and evacuation

105

When is Vaccum aspiration done

Week 6-13

106

When is Dilatation and evacuation done

Week 13-24
Not available in Scotland

107

How many stages are there in Medical Termination of Pregnancy

2 Stage process

108

What is given in the first stage of Medical Termination of Pregnancy

Oral Mifepristone 200mg

109

What type of drug is Mefepristone

Anti-progesterone
Used in Medical Termination of Pregnancy

110

How long between first and second stage in Medical termination of pregnancy

24-48hours

111

What is given at the second stage of Medical Termination of Pregnancy

Vaginal Prostaglandin
Misoprostol
Gemeprost

112

What is different in Medical Termination of Pregnancy in Late/Mid-trimester

Stage 2 (Prostaglandin) needs to be repeated

113

Examples of Prostaglandin medication used in Termination of Pregnancy

Misoprostol
Gemeprost

114

Can the second stage of medical termination of Pregnancy be done at home

In Early (

115

What are the setting that Vaccum aspiration is done under

Daycase, General anesthetics

116

What is MVA

Manual Vacuum Aspiration
Can be performed under local anesthetics

117

Risk of termination of pregnancy

BOTH: Pain, bleeds, infection, incomplete/failed procedure, SURGICAL: Uterine perforation, Cervical trauma
Future reproductive outcome may change

118

What does LGBT stand for

Lesbian
Gay
Bisexual
Transgender

119

What is Gender Identity

An individuals INTERNAL self-perception of own gender

120

What is Gender Expression

An individual's EXTERNAL gender-related physical appearance and behaviour

121

How may new cases of HIV is diagnosed each year in Scotland

on average about 400

122

What is the most commonly reported STI in sexual health clinics in Scotland

Chlamydia

123

What percentage of people with Chlamydia are asymptomatic

70% of women
50% of men

124

What causes Chlamydia?

Chlamydia trachomatis
Gram negative bacterium

125

What is the route of transmission of Chlamydia

Vaginal, oral or anal

126

What age group has the highest incidence of Chlamydia

20-24

127

What is the Pathogenesis of Chlamydia

It is unclear

128

Women with Chlamydia can develop this

Pelvic Inflammatory Disease

129

What percentage of Women with Chlamydia develop PID

~9%

130

PID secondary to Chlamydia increase the risk of what

Ectopic pregnancy by 10
Tubal factor infertility 15-20%

131

Presentation of Chlamydia in female

-Post coital or intermenstrual bleed
-Lower abdominal pain
-Dyspareunia
-Mucopurulent cervicitis

132

What is Dyspareunia

Difficult or painful intercourse

133

What is Post coital

After intercourse

134

Presentation of Chlamydia in male

-Urethral discharge
-Dysuria
-Urethritis
-Epididymo-orchitis

135

What is Chlamydia presentation of neonate

17% Conjunctivitis
20% Pneumonia

136

What is Reiter's syndrome

Medical condition typically affecting young men, characterized by arthritis, conjunctivitis, and urethritis, and caused by an unknown pathogen, possibly a chlamydia

137

What is Fitz-Hugh-Curtis Syndrome

Rare complication of PID.
Acute onset of RUQ abdominal pain aggravated by breathing, coughing or laughing. Tenderness on palpation of the right upper abdomen and percussion of lower ribs. Surprisingly there is often no or only minimal pelvic pain, vaginal discharge or cervical motion tenderness.

138

When can you test for Chlamydia

14days post exposure

139

What does NAAT stand for

Nucleic Acid Amplification Test

140

What type of sample is taken in women for Chlamydia testing

Vulvovaginal Swab

141

What type of sample is taken in men

First void urine
MSM - add rectal swab if receptive anal intercourse

142

Treatment of Chlamydia

-Azithromycin 1g ASAP
-Doxycycline 100mg BDx1week

143

What causes Gonorrhoea

Neisseria gonorrhoeae
Gram negative intracellular diplococcus

144

What is the primary site of Gonorrhea infection

Mucus membrane of urethra, endocervix, rectum and pharynx

145

Gonorrhea: What is the incubation period of urethral infection in men

Short
About 2-5days

146

Gonorrhea: What is the risk of female-->male infection

20%

147

Gonorrhea: What is the risk of male-->Female infection

50-90%

148

What percentage of Gonorrhea infections are asymptomatic in men

149

What is the presentation of Gonorrhea in male

Urethral discharge
Dysuria
Pharyngeal/rectal infections - mostly asymptomatic

150

What is the presentation of Gonorrhea in females

Asymptomatic (up to 50%)
Increased/altered vaginal discharge
Dysuria
Pelvic pain (

151

How many males/females experince complications of Gonorrhea?

3% females

152

What are some Lower genital tract complications of Gonorrhea

-Bartholinitis
-Tysonitis
-Periurethral abscess
-Rectal abscess
-Epididymitis
-Urehtral stricture

153

What are some Upper genital tract complications of Gonorrhea

-Endometritis
-PID
-Hydrosalpinx
-Infertility
-Ectopic pregnancy
-Prostatitis

154

What is Barholinitis

occurs when a Bartholin's gland is blocked and the gland becomes inflamed

155

How is Gonorrhea diagnosed, what tests

Microscopy
Culture
NAAT (Nucleic Acid Amplification Test)

156

In Endocervical Gonorrhea, which test should not be done

Microscopy, not as sensitive

157

What is the first line treatment of Gonorrhea

Ceftriaxone 500mg IM

158

What is the second line treatment of Gonorrhea

Cefixime 400mg oral

159

What is given as co-treatment when Gonorrhea is treated

Azithromycin 1g

160

What is the follow up procedure for Gonorrhea

Test for cure in all patients

161

What is Ceftriaxone

Cephalosporin antibiotic
Used to treat Gonorrhea

162

What causes Syphilis

Treponema Pallidum
A Spirochete bacteria

163

How is Syphilis transmitted

Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact (Healthcare workers)

164

What are the classifications of Syphilis

Congenital
Acquired

165

What are the stages of Accquired Syphilis

Primary
Secondary
Early latent
Late Latent
Tertiary

166

What is the incubation period of Primary Syphilis

9-90days (mean of 21)

167

What is the sign of Primary Syphilis

A lesion known as Chancre
Non-tender local lymphadenopathy

168

Where is the primary Syphilis chancre

Frequently on external genitalia (90%)
Extra-genital areas (10%)
Appear at the site of inoculation

169

Features of Syphilis primary chancre

Firm, round and painless

170

How long is the Syphilis chancre present

3-6 weeks
With or without treatment

171

What is the incubation period of Secondary Syphilis

6 weeks - 6 months

172

Features of secondary syphilis on the skin

Macular, follicular or pustular rash on palms + soles)

173

Features of secondary syphilis

Skin rashes
Lesions of mucus membranes
Generalized Lymphadenopathy
Patchy alopecia
Condylomata Lata

174

What is Condylomata Lata

Highly infectious lesion of syphilis
Exudes a serum teeming with treponemes

175

How is Syphilis diagnosed

-Demonstration of Treponema Pallidum with Dark Field microscopy or PCR
-Serological testing for antibody

176

Syphilis: Where are samples taken from for Dark Field Microscopy and PCR?

Lesions or infected lymph nodes

177

What is the Screening test for Syphilis

ELISA/EIA
(Enzyme Immunoassay)

178

What is the treatment of Early Syphilis

2.4 MU Benzathine Penicillin IM x1

179

What is the nickname for Syphilis

The great imitator

180

What is the treatment of Late Syphilis

2.4 MU Benzathine Penicillin IM x3

181

What test should be done as follow up to Syphilis treatment

Rapid Plasma Reagin (RPR)

182

What type of infections are there with Genital Herpes

Primary infection
Non-primary first episode
Recurrent infection

183

What is the incubation period of Genital Herpes primary infection

3-6 days

184

How long is the duration of the Primary infection in Gential herpes

14-21 days

185

What are the features of Primary infection of Genital Herpes

-Blistering and ulceration of external genitalia
-Pain
-External dysuria
-Vaginal or urethral discharge
-Local lymphadenopathy
-Fever and myalgia

186

What is the most common cause of Gential herpes

Herpes Simplex Virus -2
HSV-2

187

What is the duration of Recurrent episodes of gential herpes

5-7 days

188

What are the features of recurrent episodes of genital herpes

Usually unilateral, small blisters and ulcers

189

How is Genital herpes diagnosed

Swab the base of ulcer for HSV PCR

190

What is the treatment of Genital Herpes

-Oral Antiviral (Aciclovir)
-Topical Lidocaine ointment if very painful
-Saline bathing
-Analgesia

191

Which Herpes Simplex virus type has higher viral shedding

HSV-2

192

When is viral shedding higher

-First year of infection
-Individuals w/ frequent recurrent episodes

193

What is the most common viral STI in the UK

HPV
Human Papilloma Virus

194

Risks of Gential herpes in pregnancy

-Higher risk of Miscarriage
-pre-term labor
-Neonatal Herpes

195

What is the lifetime risk of HPV

80%

196

How many HPV genotypes are there

>170

197

How many HPV genotypes infect anogenital epithelium

~40

198

What are the high risk types of HPV

16,18
31,33,35,45,51,52,66

199

What is the incubation period for HPV

3 weeks to 9months
3 month median

200

HPV transmission commonly only involves one genotype. T/F

False
more than one genotype transmission is common

201

Does HPV warts need to be treated

Most cases.
20% have spontaneous clearance of warts

202

Is HPV anogenital warts treatment perfect

No.
20% will not respond to treatment

203

Which HPV genotype mostly cause Anogenital warts

HPV 6/11
>90% of cases

204

Treatment for HPV Anogenital warts

Podophyllotoxin (Warticon)
Imiquimod (Aldara)
Cryotherapy
Electrocautery

205

What is Warticon

Podophyllotoxin
Cytotoxic drug used for HPV Anogenital warts.
Not licensed for extra genital warts but widely used

206

What is Aldara

Imiquimod
Immune modifer
Used for HPV anogenital warts

207

The most common bacterial STI is

Chlamydia

208

Profuse mucopurulent discharge from the penis and painful urination are more commonly symptoms of

Gonorrhea

209

A chancre develops during which stage of syphilis

Primary

210

Which infections can lead to pelvic inflammatory disease in women

Chlamydia
Gonorrhea

211

This STI is known as the great imitator because its symptoms resemble those of other infections

Syphilis

212

The vaccine for HPV is currently recommended for females (HIV negative) age:

11-13

213

What is the guidelines for confidentiality of young people

Fraser guidelines

214

What is the Partner notification periods for Chlamydia

Male urethral - 4 weeks
Any other - 6 months

215

What is the partner notification period for Gonorrhea

Male urethral - 2 weeks
Any other - 3 months

216

What is the partner notification period for HIV

3 months before negative test
OR
before most likely time of infection

217

What is the partner notification period of Syphilis

Primary - 90 days
Secondary - 2 years
Other 3 months before most recent negative test

218

Is partner notification needed for Genital warts

No

219

What is the definition of Rape

Penetration of the vagina, anus or mouth by the penis without consent

220

What makes consent invalidated during intercourse

-Incapacitated by alcohol or drugs
- Incarcerated
-Violence or threat of violence

221

Common Sequel of rape

- Injuries
- Unwanted pregnancy
- STI's
-Psychological (PTSD, Anxiety/Depression, Psychosexual morbidity)

222

What do you need to do prior to examination of rape victim

Consider forensic examination

223

What should be considered after rape examination

HBV vaccination
PEPSE
Emergency contraception

224

What type of virus is HIV

Retrovirus

225

When was the first human infection of HIV

1930/40s
HIV-2

226

When was the first human infection of HIV that started the global pandemic

HIV-1
Late 19th century
Pandemic started in 1981

227

What is the target site for HIV

CD4+ receptors

228

On what cells can CD4+ receptors be found

Range of cells
T helper lymphocytes
Dentritic cells
Macrophages
Microglial cells

229

What is CD4+

Glycoprotein found on the surface of a range of cells

230

What does CD stand for in CD4+ receptors

Cluster of Differentiation

231

What is the role of CD4+ T helper cells

Essential for induction of adaptive immune response

232

How does the CD4+ T helper cell activate the adaptive immune response

-Recognition of MHC2 antigen-presenting cell
-Activation of B-cells
-Activation of cytotoxic T-cells (CD8+)
-Cytokine release

233

What is the effect of HIV on the immune response

-Reduced circulating CD4+ cells
-Reduced proliferation of CD4+ cells
-Reduced CD8+ T cell activation
-Reduced antibody class switching

234

What is the normal concentration of CD4+ T helper lymphocytes

500-1600 cells/mm3

235

At what concentration of CD4+ T helper lymphocytes is there a risk of opportunistic infection

236

What is the pathogenesis of HIV infection

-Infection of mucosal CD4 cell (Langerhans and Dendritic cells)
-Transport to regional lymph nodes
-Infection established within 3 days of entry
-Dissemination of virus

237

What is the incubation period of primary HIV

2-4 weeks

238

What is the presentation of Primary HIV infection

-Fever
-Rash (maculopapular)
-Myalgia
-Pharyngitis
-Headache/aseptic meningitis

239

What happens during Asymptomatic HIV infection

-Ongoing viral replication
-Ongoing CD4 count depletion
-Ongoing immune activation
-Risk of onward transmission if remains undiagnosed

240

What is the definition of an Opportunistic Infection

An infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the "opportunity" afforded by a weakened immune system to cause disease

241

What are some common opportunistic infections seen in HIV

-Pneumocystis pneumonia
-Tuberculosis
-Cerebral toxoplasmosis
-Cytomegalovirus
-Herpes Zoster
-HSv and HPV

242

What organism causes Pneumocystis pneumonia

Pneumocystis jiroveci

243

What are the symptoms of Pneumocystis pneumonia

Insidious onset
SOB
Dry cough

244

What is a clinical sign of Pneumocystis pneumonia

Exercise desaturation

245

What are the CXR findings in Pneumocystis pneumonia

May be normal
Interstitial infiltrates
Reticulonodular markings

246

What is the treatment of Pneumocystis pneumonia

High dose co-trimoxazole
(+/- Steroids)

247

What is prophylaxis of Pneumocystis pneumonia

Low dose co-trimoxazole

248

What is the tests for diagnosing Pneumocystis pneumonia

BAL (Bronchoalveolar lavage)
Immunofluorescence
+/- PCR

249

What is Cerebral toxoplasmosis

Opportunistic viral infection causing brain abscesses

250

What is the organism in Cerebral toxoplasmosis

Toxoplasma gondii
Virus

251

Symptoms and signs of Cerebral Toxoplasmosis

-Headache
-Fever
-Focal neurology
-Seizures
-Reduced consciousness
-Raised ICP

252

What is the CD4 threshold for Cerebral toxoplasmosis

253

What is the CD4 treshold for Cytomegalovirus infection

254

What does the Cytomegalovirus cause

Retinitis
Colitis
Esophagitis

255

Presentation of CMV infection

-Reduced visual acuity
-Floaters
-Abdo pain, diarrhea, PR bleeding

256

What is important to do in individuals of a CD4

Ophthalmic screening for CMV damage

257

Most common neurological compications due to HIV

-HIV-associated neurocognitive impairment
-Progressive multifocal leukoencephalopathy

258

What HIV neurology comes into mind with Reduced short term memory +/- motor dysfunction

HIV-associated neurocognitve impairment

259

What is the presentation of Progressive multifocal leukoencephalopathy

Rapidly progressing
Focal neurology
Confusion
Personality change

260

Name a few other neurological presentations of HIV

-Distal sensory polyneuropathy
-Mononeuritis multiplex
-Vacuolar myelopathy
-Aspetic meningitis
-Guillan-Barre syndrome
-Viral meningitis
-Cryptococcal meningitis
Neurosyphilis

261

Why is HIV also called "Slim's disease"

Patient's loose weight due to multiple etiologies
-Metabolic
-Anorexia
-Malabsorption
-Hypogonadism

262

Which cancers are related to HIV

Kaposi's sarcoma
Non-Hodgkins lymphoma
Cervial cancer

263

What is the causative organism in Kaposi's sarcoma

Human herpes virus 8
HHV8

264

What type of tumor is Kaposi's sarcoma

Vascular tumor

265

What is the treatment of Kaposi's sarcoma

Highly active antiretroviral therapy (HAART)
Local therapies
Systemic chemotherapy

266

What are some common non-opportunistic infections in symptomatic HIV

Mucosal candidiasis
Seborrhoeic dermatitis
Worsening psoriasis
Diarrhea
Fatigue
Lymphadenopathy
Parotitis

267

What is the most common mode of transmission of HIV

Sexual transmission
94% of all transmissions

268

What factors increase sexual transmission of HIV

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

269

What is Parentral transmission of Blood borne diseases

Injection drug use share
Infected blood products
Iatrogenic

270

How can HIV be transmitted from Mother-to-child

In utero/trans-placental
Delivery
Breast feeding

271

What is the risk of Mother-to-child transmission

1 in 4 at-risk babies will become infected if untreated HIV
If treated

272

What is the survival rate of HIV positive infants

1 in 3 will die in first year if untreated

273

What is the highest risk group for HIV

Men who have sex with men

274

What group of HIV is most likely to be undiagnosed

Heterosexual men

275

How to obtain consent for an HIV test

Explain why, normal procedure
-Benefits (improve long term health, protect partners)
-When they can get result
-Reassure confidentiality

276

How is HIV introduced to host cell

-Binds to CD4 and co-receptor (CCR5 or CXCR4)
-Penetration
-Reverse transcription (Viral RNA-->Viral DNA)
-Integration into host nucleus
-Transcription of viral proteins

277

What enzyme makes viral RNA into viral DNA

Reverse transcriptase

278

What enzyme binds viral DNA into host DNA

Integrase

279

What kind of drug is Zidovudine (ZDV)

Nucleoside analogues reverse transcriptase inhibitor
NRTI

280

What is the foundation of Highly active Anti-retroviral therapy in HIV (HAART)

Combination of three drugs from at least 2 drug classes to which the virus is susceptible

281

What is the outcome of HAART

-Reduced viral load to undetectable
-Restore immunocompetence
-Reduce morbidity and mortality
-Minimize toxicity

282

What kind of drug is Tenofovir (TDF)

Nucleotide analog reverse transcriptase inhibitor
NtRTI

283

What kind of drug is Lamivudine

NRTI
Nucleoside analog reverse transcriptase inhibitor

284

What kind of drug is Efavirenz

Non-nucleoside reverse transcriptase inhibitor

285

What is the main thing to prevent drug resistance

Adherence
Adherence
Adherence

286

Why is compliance important in HIV treatment

When one of the three drugs drop below therapeutic window the regime becomes duotherapy. Not effective

287

Which HIV drug increase risk of MI

Abacavir (ABC)
Lopinavir (LPV)

288

Which HIV drug is associated with Osteomalacia

Tenofovir (TDF)

289

Which HIV drug is associated with anemia

Zidovudine (AZT)

290

Which HIV drug is associated with psychosis

Efavirenz (EFV)

291

Which HIV drug is associated with Renal toxicity

Tenofovir (TDF)
Atazanavir (ATV)

292

Treatment for neonate if mother is HIV+

4/52 PEP
Exclusive formula feeding

293

What female reproductive organs lie in the pelvic cavity

Ovaries
Uterine tubes/Fallopian tubes
Uterus
Superior part of vagina

294

What is the space below the pelvic cavity called

Perineum

295

What female reproductive organs lie in the perineum

Inferior part of vagina
Perineal muscles
Bartholin's glands
Clitoris
Labia

296

Excess fluid within the peritoneal cavity tends to collect where? and why

Pouch of Douglas
Most inferior part of the peritoneal cavity

297

How is fluid in the Pouch of Douglas drained

Needled passed through the posterior fornix of the vagina

298

What is the other name for the Pouch of Douiglas

Recto-uterine pouch

299

What are the two pouches of the inferior part of the Parietal Peritoneum

-Vesico-uterine
-Recto-uterine (Pouch of Douglas)

300

What is the Broad ligament of the Uterus made out of

Double layer of Peritoneum

301

What is the role of the Broad ligament of the Uterus

Maintain the uterus in its correct midline position

302

What is the other ligament within the Broad ligament of the Uterus

The Round ligament of the uterus

303

What is contained within the Broad ligament of the Uterus

Fallopian/Uterine tubes
Proximal part of the round ligament

304

Where is the distal attachment of the round ligament, passes through

Passes through the deep inguinal canal ring to attach to the superficial tissue of the female perineum

305

What are the three layers of the body of the Uterus

-Perimetrium
-Myometrium
-Endometirum

306

What layer of the uterus is shed during menstrual cycle

Endometrium

307

An implantation is ectopic unless it implants in

the body of the uterus

308

What hold the Uterus in it's position

-Number of strong ligaments
-Endopelvic fascia
-Muscles of the pelvic floor

309

What is the definition of an Anteverted Uterus

Uterus tipped anteriorly relative to the axis of the vagina

310

What is the definition of Anteflexed uterus

Uterus tipped anteriorly relative to the axis of the cervix

311

What is the definition of retroverted uterus

Uterus tipped posteriorly relative to the axis of the vagina

312

What is the definition of retroflexed uterus

Uterus tipped posteriorly relative to the axis of the cervix

313

What is the most common position of the uterus

Anteverted and Anteflexed

314

What is the opening of the cervix called

External Cervical Os

315

What are the parts of the Fallopian tube, start at the ovary

Firmbriae
Infundibulum
Ampulla
Isthmus

316

Where does fertilization normally occur

Ampulla of the Uterine tube

317

What is surgical removal of both uterine tubes and ovaries called

Bilateral salpingo-oophrectomy

318

What is removal of one of the uterine tubes called

Unilateral Salpingectomy

319

What is the size and shape of the ovaries

Almond size and shaped

320

What hormones are secreted by the Ovaries

Estrogen
Progesterone

321

What hormones act on the Ovaries

Anterior pituitary hormones FSH and LH

322

What are the parts of the fornix

Anterior
Posterior
2 Lateral

323

During digital examination of the vagina, at what position is the Ischial spines palpated

Laterally
4-8 o'clock position

324

What are the nerves the supply levator ani

S3-5
Might have dual supply

325

Perineal muscles are supplied by what nerve

Pudendal nerve

326

What and where is the Perineal body

Bundle of collagenous and elastic tissue int owhich the perineal muscles attach
Between vagina and anus, just deep to skin

327

What are the glands that is located slightly posterior and to the left and right of the opening of the vagina

Bartholin's glands

328

What is infection of The greater vestibular glands called

Bartholinitis

329

What is the rounded mass of fatty tissue lying over the joint of the pubic bones called

Mons Pubis

330

What are the two lips of the vagina called

Labium major
Labium minor

331

Is Labium major or Labium minor lateral

Labium major is lateral

332

What is the area that contain both the external urethral orifice and vaginal orifice called

Vestibule

333

What is the extension of the female bed of breast

-From Ribs 2-6
-Lateral border of sternum to mid-axillary line

334

What is the space between breast and deep fascia called

Retromammary space

335

What attaches the breast to the skin

Suspensory ligaments

336

How is position of lump in breast desribed

In relation to 4 quadrants or clock face. Don't forget Axillary tail

337

What is the Axillary tail also called

Tail of Spence

338

Where does most of the lymph from the breast drain to

Ipsilateral axillary lymphnodes and then to the supraclavicular nodes

339

Inner breast quadrants may drain into what lymphnodes

Ipsi or contralateral Parasternal lymphnodes and then into supraclavicular nodes

340

Surgical Axillary node clearance levels are described in relation to what

Pectoralis minor

341

What are the levels of surgical Axillary node clearance

Level 1 - Inferior and lateral to pectoralis minor
Level 2 - deep to PM
Level 3 - Superior and medial to PM

342

What does the Axilla contain

Brachial plexus branches
Axillary artery and vein
Axillary lymphnodes

343

What is the Blood supply to the female breast

Laterally from the axillary artery
Medially from the Internal thoraic artery (Internal mammary artery)

344

How long is Depo Provera effective

12 weeks

345

Treatment for TB

RIPE (RI for 6 months - PE for first 2 months)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol