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24 Cards in this Set

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What are the components of a complete sexual history?
Contraceptive history, gynaecological history, a history of HIV risk taking behaviour, a history of recent sexual activity overseas as well as the features of a general medical history.
What are the common infective cervical causes of vaginal discharge?
Chlamydia trachomatis, Neisseria gonorrhoeae
What are the common infective vaginal causes of vaginal discharge?
Trichomonas vaginalis, Candida albicans or the condition bacterial vaginosis, which is due to an imbalance in the concentration of normal vaginal flora.
Which causes of vaginal discharge are associated with pelvic inflammatory disease (PID) or significant complications in pregnancy?
Chlamydia trachomatis, Neisseria gonorrhoeae and bacterial vaginosis
What permanent tubular damage can pelvic inflammatory disease do?
Tubal scarring which is associated with tubal factor infertility and ectopic pregnancy. The risk of these complications developing increases substantially with each episode of PID
What is the mandatory test in acute lower abdominal pain in women? Why?
Pregnancy test.
Important pregnancy related causes of pain include miscarriage (threatened, incomplete, complete or septic), accidents associated with the corpus luteum in the ovary (rupture, haemorrhage) and ectopic pregnancy, where the conceptus is implanted outside the uterus, usually in the fallopian tube but occasionally in the ovary or on the peritoneum.
What are some ovarian sources of pelvic pain?
Cyst (benign or malignant), infection, haemorrhage into cyst, torsion of enlarged ovary, endometriosis (endometrial tussie inside ovary)
What are some tubal sources of pelvic pain?
Infection/inflammation
What are some uterine causes of pelvic pain?
Endometritis, degenerating fibroid, prolapse, period pain (dysmenorrhoea)
What are some vaginal causes of pelvic pain?
Infection/inflammation eg precipitated by foreign body (retained tampon)
What are some peretoneal causes of pelvic pain?
Infection/inflammation, endometriosis, carcinomatosis
What does a pregnancy test detect?
The b subunit of the placental hormone human Chorionic Gonadotrophin (hCG) in either urine or blood (NB hCG consists of 2 subunits a and b). As blood or protein can interfere with the result of the urinary test, the blood test is used in the emergency situation.
How soon after conception is a pregnancy test positive?
The blood result is an absolute concentration of the bhCG and is sensitive enough to be indicative of a pregnancy within 7-10 days of conception. The urinary test, usually used at home or at the chemist, can remain negative until 4 weeks after conception as the concentration of the bhCG may be too low for the kit to recognise.
Which STIs receive high priority for contact tracing?
AIDS/HIV, chlamydia, gonorrhoea, Hep B, PID, syphilis
Which STIs receive low priority for contact tracing?
Genital herpes, genital warts
Who gives consent for treatment at ages 14, 16 and 18?
<14: parent or guardian must give consent
14-16: can treat minor with consent of minor only and can treat minor with consent of parent/guardian only
16-18: "mature minor" patient can consent for themselves
What is pelvic inflammatory disease?
A spectrum of upper genital tract inflammatory disorders among women that includes any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Adhesions can present additional complications. It restricted to infections of the upper genital tract caused by microorganisms that ascend from the cervix or vagina and excludes blood-born infections such as tuberculosis
What is the aetiology of PID?
Initially organisms involved may include those sexually transmitted such as Neisseria gonorrhoea, Chlamydia trachomatis.
Many other facultative (i.e. can live with or without air) and anaerobic endogenous bacteria may subsequently ascend into the upper genital tract causing a polymicrobial infection.
What is the pathogenesis of PID?
PID associated with sexually transmitted infections occurs by canalicular spread along the mucosal surfaces, site of initial infection, from the lower to the upper genital area. Intermittent microbial ascent, such as occurs with menses may also contribute to the upper genital spread
What is the role of the endocervical mucous plug in the pathogenesis of PID?
It is protective against it because it acts as a barrier.Situations in which the barrier is less protective include menses, sex steroid hormone effects of the follicular phase, douching and recent endocervical / uterine instrumentation or recent intrauterine device placement.
Use of combined oral contraceptive pill may protect against the development of PID – due to thickening of the plug
In what age group is PID most common?
<25
What are the varying clinical severities of PID?
Subclinical: first episode of chlamydia is the most frequent form of PID but is often assymptomatic

Mild to moderate: subsequent chlamydial infections will present with abdo/pelvic pain, dyspareunia (painful sex), irregular bleeding, abnormal discharge.
Gonorrhoea PID is usually acute causing moderate to severe symptoms and is infrequently seen in Australia.
What are some complications of PID? How does the type of initial organism alter this profile?
Complications include subfertility and ectopic pregnancies, chronic pain and other gynaecological morbidity.
Chlamydial PID is more likely than Gonococcal PID to result in tubal factor infertility, as recurrent infections can result in a delayed hypersensitivity reaction with intraluminal scarring and damage.
In the germ cell, which hormones are secreted so that the gonads develop into testes and the internal and external genitalia become male?
Sertoli cells which secrete anti-mullerian hormone (AMH) and Leydig cells which secrete testosterone. If the germ cells do not contain a "testis determining gene" on the Y chromosome then there is no secretion of AMH or testosterone, the gonads become ovaries and the internal and external genitalia become female.