HD1

Question 1

Describe the two stages of chlamydia lifecycle [2]

Answer 1

1. Enters cell and forms inclusions bodies called elementary bodies
2. Elementary bodies reorganise into smaller reticulate bodies
3. Reticulate bodies replicate and mature and turn back into elementary bodies
4. Cell ruptures and releases elementary bodies

Question 2

Which cells structure (& where) are most commonly affected infected by C. trachomotis? [2]

Answer 2

iii. Infects columnar epithelial cells
1. E.g. those at squamous-columnar junction at cervix

Question 3

Chlaymdia

iv. Primary site of infection is the []?

Answer 3

iv. Primary site of infection is the cervix

Question 4

Describe the serovars subspecies of chlaymida [3]

Answer 4

1. Trachoma: A-C:
   a. Contagious eye infection
2. Urogenital D-K
   a. Classic chlamydia infection
3. LGV
   a. Genital ulcer disease
   i. Causes lymphogranuloma venereum

Question 5

Describe Fitz-Hugh Curtis symptoms associated with C. trachomatis infection

Answer 5

Pain in the right hypochondrium and fever

This pain is caused by adhesion of the anterior hepatic surface and the abdominal wall due to spread of infection

Question 6

Management for C. trachomatis [2]

Answer 6

1. Doxycycline everyday for a week
2. Azithromycin once a day for three days

Question 7

What type of bacteria is C. trachomatis ? [1]

Answer 7

1. Gram negative obligate (aerobic) bacteria

Question 8

Chlamydia

Problems associated with infection? [2]

Answer 8

i. Infertility
ii. Reactive arthritis

Question 9

Describe the test used to diagnose C. trachomatis [1]

Answer 9

ii. Positive nucleic acid amplification test (NAAT; checks directly for RNA or DNA of organism)
1. Vulvovaginal swab
2. Endocervical swab
3. First catch urine sample
4. Urethral swab in men
5. Anal swab
6. Pharyngeal swab

Question 10

Describe the pathophysiology of PID [2]

Answer 10

1. Causes epithelial damage can cause opportunistic entry to other pathogens
2. Infection is caused by disruption of the protective cervical barrier and direct introduction into the endometrial cavity from vagina or cervix

Question 11

What is the most common cause of PID? [1]

Answer 11

i. Chlamydia trachomatis

Question 12

Complications of PID? [5]

Answer 12

i. Infertility (1/10 women)
ii. Ectopic pregnancy
iii. Chronic pelvic pain
iv. Tubo-ovarian absecess
v. Fitz-Hugh-Curtis syndrome

Question 13

How do you diagnose PID? [3]

Answer 13

i. Elevated white blood cell count
ii. Presence of polymorphonuclear cells on vaginal smear
iii. Genetic probe / culture of vaginal secretions for chlamydia or gonorrhoea

Question 14

Know this

Management of PID [3]?

Answer 14

i. Parenteral cephalosporin & oral doxycycline & oral metronidazole

Question 15

Describe the MoA for:

• Parenteral cephalosporin
• oral doxycyclin
• oral metronidazole

Answer 15

Cephalosporin:
* The beta-lactam rings bind to the penicillin-binding protein and inhibit its normal activity. Unable to synthesize a cell wall, the bacteria die

Doxycycline:
* allosterically binding to the 30S prokaryotic ribosomal unit during protein synthesis

metronidazole
* binds deoxyribonucleic acid and electron-transport proteins of organisms, blocking nucleic acid synthesis

Question 16

Describe pathophysiology of ectopic pregnancy [1]

Answer 16

ii. Ectopic grows, causes the outer layer of fallopian tube to stretch
1. Leads to tubal rupture and bleeding (can be fatal)
iii. Occurs 6-8 weeks of gestation

. Medical emergency

Question 17

Signs and symptoms of ectopic pregnancy? [6]

Answer 17

1. Missed period
2. pain in the tip of your shoulder
   a. Sign that this pain is caused by blood leaking into the abdomen and is a sign that the condition is getting worse
3. Constant lower abdomen pain in right or left iliac fossa
4. Vaginal bleeding
5. Lower abdomen tenderness
6. Cervical motion tenderness (pain when moving cervix in bimnaul exam)
7. Palour

Question 18

State the 4 things you do to diagnose an ectopic pregnancy? [4]

Answer 18

i. Transvaginal ultrasound
ii. Positive pregnancy test
iii. Blood test:. Beta HCG levels (double every 48 hrs – if this is occurring its also a sign)
iv. Laparoscopy

Question 19

Describe ultrasound findings of an ectopic pregnancy [2]

Answer 19

1. ID a gestational sac containing a yolk sac or fetal pole in fallopian tube / not intrauterine
2. Mass representing a tubal ectopic pregnancy moves separately to the ovary
3. ID empty uterus
4. Fluid in the uterus: pseudo-gestational sac
5. sometimes described as a ‘tubal ring’ or ‘bagel sign’:

Question 20

Describe the treatment plan for ectopic pregnancy if requires:

Expectant management
Medical managment
Surgical management

Answer 20

1. Expectant management
   a. Await natural termination
   b. Needs to not ruptured
   c. No significant pain
   d. No visible heartbeart
2. Medical management
   a. IM Methotrexate (in buttock)
   i. Need to have oral contraceptives 3 months after treatment because is tetragenic)
3. Surgical management (if tube has ruptured)
   a. Laparoscopic salpingectomy
   b. Laparoscopic salpingotomy

Question 21

Difference between

a. Laparoscopic salpingectomy
b. Laparoscopic salpingotomy

Answer 21

Salpingectomy is the surgical removal of a fallopian tube.

Salpingostomy (also called neosalpingostomy) is the creation of an opening into the fallopian tube, but the tube itself is not removed in this procedure.15

Question 22

Presentation of rupture ectopic pregnancy? [5]

Answer 22

Sudden, severe abdominal or pelvic pain ·
Dizziness or fainting
Pain in the lower back
tachycardia
hypotension

Question 23

Most common place for ectopic pregnancy to occur? [1]

Answer 23

ampulla

Question 24

What is the classification of the organism chlamydia trachomatis? (1 mark)

Answer 24

Gram negative obligate intracellular microorganism

Question 25

Outline briefly the pathophysiology of chlamydial infection leading to pelvic inflammatory disease. (2 marks)

Answer 25

1st stage vaginal or cervical infection. 2nd stage direct ascent of the microorganism from the vagina or cervix to upper genital tract with infection and inflammation of these structures.

Question 26

Name the two of the three complications of pelvic inflammatory disease and the reason that this arises. (3 marks)

Answer 26

Any 2 from **Chronic pelvic pain** (0.5 marks) : This pain is thought to be related to c**yclic menstrual changes,** but it also may be the result of adhesions or hydrosalpinx. (1 mark) **Infertility** (0.5 marks): Infection and inflammation can lead to **scarring and adhesions within tubal lumens**. The rate of infertility increases with the number of episodes of infection. (1 mark) **Ectopic pregnancy** (0.5 marks): Ectopic pregnancy is a direct result of **damage to the fallopian tube**. (1 mark)

Question 27

Explain why transvaginal ultrasound is the preferred imaging modality for early pregnancy monitoring. (2 marks)

Answer 27

By inserting the ultrasound wand into the vagina it provides a **better view of the reproductive organs** and the **contents** of the **uterus** as it is **closer** to the structures (1 mark) and the **ultrasound waves do not have to travel through the abdomen** (1 mark)

Question 28

What is the mode of action of methotrexate in this case? (2 marks)

Answer 28

Its mechanism of action, **competitive inhibition of folate-dependent steps in nucleic acid synthesis**, (1 mark) **effectively kills the rapidly dividing ectopic trophoblast**. (1 mark) ( if the student puts Methotrexate works by blocking the enzymes in the body that maintain the pregnancy. It stops the tissue from growing bigger and prevents it from rupturing (bursting). The pregnancy tissue is then gradually reabsorbed by the body. (1 mark) only)

Question 29

Which organism causes more severe PID? [1]

Answer 29

* **Neisseria gonorrhoeae** tends to produce more severe PID