YOU GOT THIS

Question 1

BV

1. Cause
2. Symptoms

Answer 1

1. Mixture of bacteria, occurs when normal vaginal flora is disrupted
2. ASYMPTOMATIC
   - Fishy thin discharge, esp after sex
   - May have irritation (not itchy)

Question 2

BV

3. Investigations
4. Treatment

Answer 2

3. Microscopy - CLUE CELLS. Positive AMINE test

4. METRONIDAZOLE

Question 3

Gonorrhoea

1. Cause
2. Symptoms

Answer 3

1. Gram -ve diplococcus Neisseria gonorrohoeae

2. 50% asymptomatic, inc/altered discharge, lower abdo pain, dysuria WITHOUT frequency

Question 4

Gonorrhoea

3. Investigations
4. Treatment

Answer 4

3. Culture

4. CEFTRIAXONE 500mg stat (IM) + AZITHROMYCIN 1g stat (PO)

Question 5

Trichomonas Vaginalis

1. Cause
2. Symptoms

Answer 5

1. Parasite Trichomonas vaginalis. Usually sexually acquired
2. • Yellow/green, thin, frothy, offensive discharge
   • Irritation
   • Dyspareunia
   • Dysuria WITHOUT frequency

Question 6

Trichomonas Vaginalis

3. Investigations
4. Treatment

Answer 6

3. STRAWBERRY CERVIX & culture
4. METRONIDAZOLE 400mg BD 5/7

N.B. send to GUM as often has another STD

Question 7

Fragile X Syndrome

1. Cause
2. Presentation

Answer 7

1. Mutated FMR1 gene on X chromosome
2. LARGE TESTICLES & LONG FACE
   - Hyperextensible fingers, soft skin, hypotonia
   - Delayed milestones
   - Learning difficulties, IQ <70

Question 8

Williams Syndrome

1. Cause
2. Presentation

Answer 8

1. Deleted gene from chromosome 7 - autosomal DOMINANT
2. “Elfin” appearance
   - Short
   - Learning disability
   - Friendly & extroverted
   - Transient neonatal hypercalcaemia
   - Aortic stenosis

Question 9

Edwards Syndrome

1. Cause
2. Presentation

Answer 9

1. Trisomy 18

2.

• Rocker bottom feet
• Microcephaly
• Low set ears, micrognathia, cleft lip/palate
• Overlapping fingers
• Clenched hands & underdeveloped thumns/nails
• Absent radius

N.B 80% cases are FEMALE

Question 10

Patau Syndrome

1. Cause
2. Presentation

Answer 10

1. Trisomy 13
2. • Congenital heart defects (80%)
   • Microcephaly
   • Midline facial defect
   • Cleft lip/palate, small eyes, micropthalmia

Question 11

Noonan Syndrome

1. Cause
2. Presentation

Answer 11

1. Genetic - autosomal DOMINANT
2. • Webbed neck
   • Pectus excavatum
   • Short
   • Pulmonary stenosis

Question 12

Pierre-Robin Syndrome

1. Cause
2. Presentation

Answer 12

1. DNA mutation near SOX9 gene
2. • Micrognathia
   • Posterior tognue displacement –> upper airway obstruction
   • Cleft palate

Question 13

Prader-Willi Syndrome

1. Cause
2. Presentation

Answer 13

1. Loss of function of genes on chromosome 15

2. Hypotonia, hypogonadism, obesity

Question 14

Cri du chat Syndrome

1. Cause
2. Presentation

Answer 14

1. Chromosome 5p deletion
2. Characteristic cry
   - Feeding difficulties
   - Poor weight gain
   - Learning difficulties
   - Microcephaly
   - Micrognathism

Question 15

Hypersensitivity reaction
- Mediator & mechanism

Type 1 e.g. atopy
Type 2 e.g. blood transfusion
Type 3 e.g. erythema nodosum
Type 4 e.g. allergic contact dermatitis
Type 5 e.g neonatal hyperthyroid
Type 6 e.g. tumour rejection

Answer 15

1. IgE - RAPID (30 mins) reaction to specific antigens
2. IgG & IgM - intravascular reaction
3. Immune complex - activate complement to cause local tissue damage
4. Lymphocytes - secondary cellular response, appears 48-72hrs after exposure
5. IgG - directed towards cell surface antigens
6. Killer cells - lyse target cells coated by antibody

Question 16

Malaria

1. Presentation
2. Investigations
3. Treatment

Answer 16

Manifests weeks after leaving endemic area

1. HEADACHE
   - Flu-like illness
   - Fever is REMITTING (diurnal variation)
   - Diarrhoea/GI sx

Severe –> splenic rupture, cerebral malaria, anaemia, renal failure & pulmonary oedema

2. Giemsa-stained thick & thin peripheral blood smears
3. Artemsinin combo therapy (ACT), quinine

Question 17

Typhoid

1. Cause
2. Presentation
3. Investigation

Answer 17

1. Salmonella typhi

Typhoid fever begins 7-14 days after ingestion

2. RISING TEMP over course of each day
   - 1st week: GI sx, blanching rash
   - 2nd week: splenomegaly, bradycardia
   - 3rd week: abdo distension, “pea soup” diarrhoea, bowel perf + peritonitis
   - 4th week: slow improvement
3. Culture

Question 18

Dengue

1. Cause
2. Presentation
3. Investigation

Answer 18

1. Dengue VIRUS (mosquitoes)
2. HIGH FEVER (>40) & FACIAL FLUSHING
   - Red skin mottling
   - Headache, N+V, myalgia, arthralgia
   - Haemorrhagic sx
   - Abdo pain
   - Cardiomyopathy
3. Serology - rise in ANTIBODY titre in IgG/IgM

Question 19

Schistosomiasis

1. Cause
2. Presentation

Answer 19

1. Flatworm (5 species) that live in fresh water
2. • Acute: “swimmer’s itch” & Katayama syndrome (mimics generic acute illness)
   • Chronic depends on type, can involve most organs

Question 20

Amoebiasis

1. Cause
2. Presentation

Answer 20

1. Entamoeba histolytica transmitted via ingestion of cystic protozoa
2. LIVER ABSCESS
   - Dysentery
   - Colitis sx

Question 21

Toxoplasmosis

1. Cause
2. Presentation
   - Adults
   - Fetus/immunocompromised

Answer 21

1. Toxoplasma gondii parasite (CATS)

2.
- Self-limiting flu-like illness

• CNS involvement (encephalitis, hemiparesis, speech changes, neuropsych)
• Pneumonitis
• Ocular (pain + loss of visual acuity)

Question 22

Chlamydia

1. Cause
2. Presentation
3. Complications

Answer 22

1. Gram-negative bacteria
2. ASYMPTOMATIC
   - Tracoma (ocular)
   - GU infections
   - Lymphogranuloma venereum (painLESS genital ulcers + lymph nodes)
3. PID, ectopic pregnancy, tubal infertility, epidydimo-orchitis

Question 23

Chlamydia

1. Investigation
2. Treatment

Answer 23

1. Nucleic acid amplification tests (NAATs)
   - Men first void urine
   - Women swab or urine
2. Azithromycin 1x dose (or doxy BD for 7/7)