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Phase 2 - RDH > Week 5 > Flashcards

Week 5 Flashcards

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1
Q

standard sexual health screening

A

chlamydia and gonorrhea (naat test)

syphilis and HIV (blood test - big edta bottle)

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2
Q

how are naat tests taken

A

female - self taken vulvovaginal swab
male - urine

homosexual male - urine, throat swab and self taken rectal swab

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3
Q

describe gonorrhoea

A

bacterial
caused by gram negative diplococcus
infects mucous membranes of urethra, endocervix, rectum, pharynx and conjunctiva
inoculation through secretions from one mucous membrane to another

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4
Q

signs and symptoms of gonorrhoea

A

penile urethra: urethral discharge, dysuria

vaginal: change in discharge, abdo/pelvic pain, dysuria, altered bleeding

pharynx: usually asymptomatic

rectum: usually asymptomatic

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5
Q

signs and symptoms of chlamydia

A

penile urethra: majorly asymptomatic, discharge, dysuria, meatal discomfort

vaginal: most asymptomatic, cervicitis or contact bleeding, intermenstrual bleeding, change in discharge, pelvic pain

pharynx: usually asymptomatic

rectum: can present with proctitis

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6
Q

treatment for chlamidyia

A

doxycycline

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7
Q

complications of gonorrhoea

A

pelvic inflammatory disease
epididymo-orchitis

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8
Q

describe mycoplasma genitalium

A

bacteria
1-2% prevalence
some people get symptoms of urethritis/PID
treatment not indicated unless symptoms or partner has symptoms

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9
Q

signs and symptoms of trichomonas vaginalis

A

vaginal: frothy yellow discharge with intense itch

penile: usually asymptomatic, can have urethritis

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10
Q

describe syphilis

A

treponema pallidum
gram negative spirochete
normally transmitted sexually but can be vertical
epidemic
more common in MSM

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11
Q

divisions of syphilis

A

primary - 9 to 90 days (chancre - penile ulcer)
secondary - 3 months to 2 years (rash)
tertiary - up to 15 years (neuro and cardiac)

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12
Q

describe anogenital warts

A

caused by HPV
high population prevalence
itchy

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13
Q

treatment for anogenital warts caused by HPV

A

cryotherapy
topical treatments
surgical excision

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14
Q

describe HSV

A

types 1 and 2
as time goes on, any breakouts get less severe
not blood test, viral pCR swab

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14
Q

describe scabies

A

itch, especially at night
- caused by mite excrement which triggers hypersensitivity
burrows
- classically in web spaces, wrist, elbows, nipples

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15
Q

describe phthirus pubis

A

transmitted by close bodily contact
lives on course body hair

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16
Q

aims of immunisation

A

to protect those at highest risk
to eradicate, eliminate or contain disease

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17
Q

pros and cons of live vaccines

A

indice long-lasting immunity
strong immune response evoked

can revert to virulence
poor stability

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18
Q

pros and cons of inactivated vaccines

A

shorter lasting immunity
adjuvant needed
need several doses

unable to cause infection
stable
fewer contraindications

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19
Q

pros of antibody preparations

A

rapid
preventative
can be given to those where vaccine is contraindicated

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20
Q

cons of antibody preparations

A

expensive
potential for adverse effects
limited evidence base for some
no lasting immunity

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21
Q

outline the fraser guidelines (UPSSI)

A

Understanding
Parental Involvement
Sexual activity ongoing
Suffering
Interests

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22
Q

Outline the three emergency contraception options

A

Cu IUD
Ulipristal Acetate
Levonorgestrel

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23
Q

Describe Cu IUD

A

Gold standard EC
Within 5d first UPSI in cycle
Within 5d expected date ovulation

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24
Describe ulipristal acetate
Licensed for use 120 hours following UPSI Progesterone receptor modulator Thought to delay ovulation >effective than LNG EC
25
describe Levonorgestrel EC
Licensed up to 72h following UPSI Ineffective >96h Thought to delay ovulation Double LNG EC dose: - BMI >26 - Weight > 70kg
26
4 modes of action of contraception
prevents ovulation thickens cervical mucus - blocks sperm prevents implantation prevents fertilisation
27
advantages and disadvantages of implant
very effective lasts for 3 years can forget about it once its in place insertion and removal procedure by healthcare professional unpredictable effect on periods
28
advantages and disadvantages of LNG-IUD
Very effective Lasts for 3-8 years Can forget once in place Fewer or no periods Minor medical procedure to insert - can be painful Risk of spotting for 3-6 months after insertion Risk of perforation and expulsion Small chance of infection during first 21 days
29
advantages and disadvantages of IUD
very effective lasts 5-10 years can forget about it no hormonal side-effects and usual menstrual cycle used as EC minor medical procedure to insert - can be painful risk of heavier/worse periods risk of perforation and expulsion small chance of infection in first 21 days
30
advantages and disadvantages of progestogen-only injection
effective likely to stop periods reduces ovarian and endometrial cancer risk don't need to remember to take daily need to remember to repeat every 3 months can delay return to fertility erratic bleeding is common initially likely to stop periods association with weight gain may slightly reduce bone density
31
describe advantages and disadvantages of combined hormonal contraception
easy to use, controlled by woman effective regular withdrawal bleed can improve heavy and painful periods can improve skin/acne reduces ovary, endometrium and colon cancer risks need to remember to take daily many medical contraindications association with breast and cervical cancer
32
contraindications of combined hormonal contraception
CVD VTE Migraine Cancer: breast / liver post natal
33
outline the four categories of UKMEC
UK medical eligibility criteria UKMEC1: No restrictions UKMEC2: Advantages outweigh risks UKMEC3: Risks outweigh advantages UKMEC4: unacceptable health risk
34
describe advantages and disadvantages of progestogen-only pill
easy to use, controlled by woman effective fewer contraindications than CHC can reduce periods reduces ovarian and endometrial cancer risk need to remember to take daily unpredictable effect on periods
35
describe testosterone
steroid hormone produced in leydig cells circulates bound to SHBG free testosterone is biologically form activated to more potent form (dihydrotestosterone) in target tissues
36
describe control of gonadal function via HPG-Axis
Gonadotropin releasing hormone released from hypothalamus episodically. Gnrh acts on anterior pituitary and causes synthesis and release of LH and FSH in males, LH acts on leydig cells to produce testosterone. FSH acts on sertoli cells to induce spermatogenesis. Testosterone feeds back to pituitary and hypothalamus and shuts off gonadotropin releasing hormone and gonadotrophin.
37
male gonadal function
growth of - sex organs skeletal muscles epiphyseal plate larynx secondary characteristics erythropoiesis behaviour libido erectile function spermatogenesis
38
clinical features of hypogonadism in children
slow growth in teens no pubertal growth spurt lack of secondary sexual development
39
clinical features of hypogonadism in adults
low mood poor libido erectile dysfunction sparse body/facial hair low trauma fractures hot sweats poor energy and muscle bulk
40
testing for suspected hypogonadism
testing for testosterone - early morning fasting - free testosterone >200 total testosterone >10 SHBG testing for LH & FSH - determine pituitary or testicular cause
41
define HYPOgonadotrophic hypogonadism
Problem with hypothalamus or pituitary (secondary hypogonadism) LH/FSH normal or low Low testosterone
42
define HYPERgonadotrophic hypogonadism
Problem with testes (primary hypogonadism) LH/FSH high Low testosterone
43
potential causes of hypogonadotropic hypogonadism
pituitary disease/tumour head injury isolated LH/FSH deficiency
44
describe Kallman's syndrome
most common form of isolated gonadotropin deficiency failure of cell migration of GnRH cells to hypothalamus may also be associated with deafness, renal agenesis, cleft lip/palate
45
genetics of kallman's syndrome
most commonly an isolated gene mutation X-linked - absence of KAL genes (KAL1) Autosomal dominant (KAL2) Autosomal recessive (KAL3)
46
3 forms of primary gonadal disease
chromosome defects, eg. Kleinfelter's seminiferous tubule or adult leydig cell failure cryptorchidism
47
describe klinefelter's syndrome
most common genetic cause of male hypogonadism clinically manifests at puberty XXY elevated LH & FSH - but seminiferous tubules regress & leydig cells do not function normally, low testosterone
48
clinical features of kleinfelters
variation - delayed puberty - reduced testicular volumes - reduced 2° male sexual characteristics - behavioural issues/learning difficulties
49
treatment for kleinfelters
androgen replacement therapy - IM - Topical fertility treatment - hCG - Recombinant LH & FSH - GnRH pumps
50
side effects of testosterone treatment
mood issues libido issues Acne gynaecomastia increased haematocrit / polycythaemia
51
outline the components of a cigarette
acrolein arsenic benzene cadmium formaldehyde
52
how many people smoke in scotland
13.5% of adults aged 18+
53
factors associated with youth smoking uptake
family member who smokes lower socioeconomic status adverse childhood experience lower levels of parental supervision truanting and exclusion from school >5 hours/day social media use
54
factors of smoking cessation
willpower one-to-one or group support sessions nicotine replacement therapy bupropion
55
sources if behaviour on behaviour change wheel
capability opportunity motivation
56
intervention functions on behaviour change wheel
education persuasion incentivisation coercion training enablement modelling environmental restructuring restrictions
57
policy categories in behaviour change wheel
environmental/social planning communication/marketing legislation service provision regulation fiscal measures guidelines
58
where is the hypothalamus
in the brain, just below the thalamus
59
where is the pituitary
in the brain, just below the hypothalamus
60
describe the hypothalamus
links the nervous system to the endocrine system part of the limbic system controls body temp, hunger, sleep, thirst etc
61
describe the pituitary
endocrine gland suspended from the underside of the brain by the pituitary stalk has an anterior and a posterior portion
62
what is produced by posterior pituitary
anti-diuretic hormone oxytocin
63
what is produced by the anterior pituitary
FSH/LH growth hormone thyroid stimulating hormone adrenocorticotropic hormone prolactin
64
pre-pubertal HPC axis
Hypothalamus inhibited by GABA until GABA is switched off by stimulatory factor kisspeptin which activates the hypothalamus
65
define precocious puberty
unusually early stage girls below 8, boys below 9
66
define delayed puberty
lacks or has incomplete development of specific sexual characteristics girls no sign of breast development or menstruation by 13 boys no testicular enlargement by 14
67
causes of gonadotropin dependence
tumours on hypothalamus or pituitary cerebral malformations injuries to CNS early breast/testicular development
68
causes of gonadotropin independence
tumours on gonads or liver adrenal gland hyperplasia exogenous androgenic or oestrogen steroids only pubic/axillary hair before 8
69
describe kisspeptin
kisspeptin neurons reside and synapse within the hypothalamus in the AVPV and ARC nucleus acts with GABA to initiate development
70
describe kisspeptin and puberty
during puberty, KiSS1 neurons increase in the AVPV of the hypothalamus and the receptors on GnRH neurons. (GPR54) Larger increase in females than males due to testosterone
71
describe the role of leptin
leptin stimulates an increase in kisspeptin neurons in hypothalamus. released from adipose tissue when adolescents reach a certain age
72
vaccines given at 8 weeks
DTaP/IPV/Hib/HepB MenB Rotavirus
73
vaccines given at 12 weeks
DTaP/IPV/Hib/HepB PCV Rotavirus
74
vaccines given at 16 weeks
DTaP/IPV/Hib/HepB MenB
75
vaccines given at 1 year
Hib/MenC PCV booster MMR MenB booster
76
vaccines given at 3y4m or soon after
DTaP/IPV MMR
77
vaccines given at twelve years
HPV
78
vaccines given at 14 years
Td/IPV MenACWY
79
vaccines given at 65
PPV Inactivated influenza Shingles
80
vaccines given at 70-79
shingles RSV (at 75)
81

Phase 2 - RDH (5 decks)

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