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Question 1
Incorrect
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You are investigating the mechanisms of action of the currently available treatments for the human immunodeficiency virus (HIV).
Regarding HIV, which of the following statements is accurate?Your Answer: HIV is an adenovirus
Correct Answer: HIV may be transmitted by oral sex
Explanation:HIV: Transmission, Replication, and Types
HIV, or human immunodeficiency virus, is a virus that attacks the immune system and can lead to acquired immunodeficiency syndrome (AIDS). Here are some important facts about HIV transmission, replication, and types:
Transmission: HIV can be transmitted through certain body fluids, including blood, breast milk, and vaginal/seminal fluids. If these fluids come into contact with a mucous membrane or broken skin, HIV can be transmitted. This means that oral sex can also transmit HIV if vaginal/semen fluids come into contact with the oral cavity.
Replication: HIV is an RNA retrovirus that requires reverse transcriptase to replicate. It contains two copies of genomic RNA. When a target cell is infected, the virus is transcribed into a double strand of DNA and integrated into the host cell genome.
Types: HIV-1 is the most common type of HIV in the UK, whereas HIV-2 is common in West Africa. HIV-1 is more virulent and transmissible than HIV-2. Both types can be transmitted by blood and sexual contact (including oral sex).
Depletion of CD4 T cells: HIV principally targets and destroys CD4 T cells (helper T cells). As a result, humoral and cell-mediated responses are no longer properly regulated, and a decline in immune function results.
Overall, understanding how HIV is transmitted, replicates, and the different types can help in prevention and treatment efforts.
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This question is part of the following fields:
- Sexual Health
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Question 2
Incorrect
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A 28-year-old woman visits her GP complaining of fever, malaise and headache. During the examination, the GP notices a macular rash on her trunk and limbs. The patient confirms that the rash is not causing any itching. The GP suspects that the patient may have developed secondary syphilis. If the patient had untreated chancre-associated primary syphilis, how many weeks would it take for secondary syphilis to appear?
Your Answer: 2–3 weeks
Correct Answer: 2–8 weeks
Explanation:The Timeline and Symptoms of Secondary Syphilis
Secondary syphilis is a multisystem disease that usually develops between 2 and 8 weeks following the appearance of a chancre. In women, chancres can be found on the labia, vulva, or cervix, making it easy to miss the primary stage.
Symptoms of secondary syphilis include mild fever, malaise, and headache. A rash on the trunk and limbs is also common, which may involve the palms and soles of the feet. If left untreated, the rash can last up to 12 weeks.
It’s important to note that clinical manifestations of secondary syphilis will resolve without treatment, but relapse may occur within the first year.
In summary, the timeline for secondary syphilis is between 2 and 8 weeks following the chancre, and symptoms include fever, malaise, headache, and a rash on the trunk and limbs. Early detection and treatment are crucial to prevent further complications.
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This question is part of the following fields:
- Sexual Health
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Question 3
Incorrect
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A 26-year-old woman visits a gynaecologist to discuss her options for contraception. The doctor suggests the insertion of a copper-bearing intrauterine device (IUD) and explains its mechanism of action and potential risks. What is the frequency of uterine perforations as a complication of IUD placement?
Your Answer: 1 in 100 000
Correct Answer: 1 in 1000
Explanation:Understanding the Risks and Mechanisms of Copper-Bearing IUDs
Copper-bearing intrauterine devices (IUDs) are a popular form of reversible contraception that work through various mechanisms, including thickening cervical mucous, inhibiting sperm mobility, and reducing the likelihood of implantation. However, there are absolute contraindications to their use, such as pregnancy or recent childbirth, irregular vaginal bleeding, and gynecological cancer. Complications can include bleeding, pain, infection, discharge, and rare occurrences of uterine perforation, pelvic infection, expulsion, and ectopic pregnancy. The risk of uterine perforation is quoted as 1 in 1000 insertions, making it a rare but important consideration for those considering copper-bearing IUDs.
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This question is part of the following fields:
- Sexual Health
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Question 4
Correct
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A 35-year-old woman presents to her primary care physician seeking the combined oral contraceptive pill (COCP). She has a history of pelvic inflammatory disease and had an ectopic pregnancy that was treated with methotrexate a year ago. Additionally, she is a heavy smoker, consuming 20 cigarettes per day. Her family history is significant for BRCA1 mutation in her mother and sister, but she declines genetic testing. What would be an absolute contraindication for the COCP in this patient?
Your Answer: Smoker
Explanation:The combined oral contraceptive pill (COCP) is a popular form of birth control, but it is not suitable for everyone. There are absolute contraindications, which mean that the COCP should not be used under any circumstances, and relative contraindications, which require careful consideration before prescribing.
Absolute contraindications include smoking 15 or more cigarettes a day and being over 35 years old, hypertension, major surgery with prolonged immobilization, secondary Raynaud’s disease, systemic lupus erythematosus, positive for antiphospholipid syndrome, current or history of venous thromboembolism, migraine with aura, current breast cancer, liver cirrhosis, viral hepatitis, and diabetic nephropathy/retinopathy/neuropathy.
Relative contraindications include smoking less than 15 cigarettes a day and being over 35 years old, being 6 weeks to 6 months postpartum and breastfeeding, being less than 21 days postpartum and not breastfeeding, having a body mass index of 35 or higher, having a family history of venous thromboembolism in a first-degree relative, having migraines without aura, having a history of breast cancer without recurrence for 5 years, using certain anticonvulsants, having dyslipidemia, undergoing rifampicin therapy, and having a previous use of methotrexate.
A history of pelvic inflammatory disease or prior ectopic pregnancy is not considered a contraindication to the use of the COCP. The possibility of a BRCA mutation is a controversial topic, and while there is evidence of a small increase in breast cancer risk with COCP use, it is not an absolute contraindication. It is important to consult with a healthcare provider to determine the best form of birth control for individual circumstances.
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This question is part of the following fields:
- Sexual Health
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Question 5
Correct
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After fertilisation, which part of the spermatozoon remains in the cytoplasm of the oocyte?
Your Answer: Nucleus
Explanation:During fertilization, the nucleus of the sperm carries the genetic material needed to create the paternal pronucleus and subsequently the zygote. The acrosome discharges its hydrolytic enzymes to help the sperm penetrate through the corona radiata and the zona pellucida. The sperm nucleus enters the cytoplasm of the egg, along with the midpiece, mitochondria, centrosome, and kinocilium of the sperm. Fertilization triggers changes in the chemistry of the zona pellucida and the discharge of cortical granules in the egg cytoplasm, which prevent additional sperm from fertilizing the egg. The sperm nucleus decondenses to form the haploid male pronucleus, which fuses with the haploid female pronucleus to form a diploid zygote nucleus. The midpiece and kinocilium of the sperm are destroyed, while the plasma membrane covering the tail remains attached to the egg plasma membrane. Mitochondrial diseases are inherited exclusively along the maternal line because the male mitochondria are destroyed soon after fertilization.
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This question is part of the following fields:
- Sexual Health
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Question 6
Incorrect
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A 29-year-old woman presents to the Emergency Department with severe lower abdominal pain for the last day. She reports that she has had some bloody vaginal discharge. She is currently sexually active. She has a fever of 38.1 °C. On examination, she has uterine tenderness and there is severe cervical motion tenderness.
What is the most important initial investigation in helping to reach a diagnosis?Your Answer: Abdominal ultrasound
Correct Answer: Pregnancy test
Explanation:The Importance of Initial Investigations in a Patient with Lower Abdominal Pain: A Case Study
When a patient presents with lower abdominal pain, it is important to conduct initial investigations to determine the underlying cause. In this case study, the patient exhibits symptoms consistent with pelvic inflammatory disease, but it is crucial to rule out an ectopic pregnancy as it can lead to serious complications.
Pregnancy Test: The most important initial investigation for women of childbearing age who present with abdominal pain is a pregnancy test. This test can quickly determine if the patient is pregnant and if an ectopic pregnancy is a possibility.
Erythrocyte Sedimentation Rate (ESR): While an ESR test can identify infection and inflammation, it is of limited diagnostic or therapeutic benefit in this case and would not affect the patient’s management.
Abdominal Ultrasound: Although an abdominal ultrasound can identify potential issues, such as an ectopic pregnancy, a pregnancy test should take priority in this case.
Cervical and Urethral Swab: A swab can identify sexually transmitted diseases that may be causing pelvic inflammatory disease, but it is not the most important initial investigation.
Full Blood Count: While a full blood count can identify potential infections and provide a baseline for admission, it is unlikely to help reach a diagnosis and is not the most important initial investigation.
In conclusion, initial investigations are crucial in determining the underlying cause of lower abdominal pain. In this case, a pregnancy test is the most important initial investigation to rule out an ectopic pregnancy, followed by other tests as necessary.
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This question is part of the following fields:
- Sexual Health
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Question 7
Correct
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A 20-year-old student visits the Genitourinary Medicine (GUM) Clinic with concerns about a recent sexual encounter. He had unprotected sex with a woman and has since developed a purulent urethral discharge and painful urination. Gram-negative diplococci were identified in specimens taken from him. What is the probable causative organism for this patient's symptoms?
Your Answer: Neisseria gonorrhoeae
Explanation:Diagnosing and Differentiating Sexually Transmitted Infections
Sexually transmitted infections (STIs) are a common health concern, and prompt diagnosis and treatment are crucial to prevent complications and further transmission. One such STI is gonorrhoeae, caused by the bacterium N. gonorrhoeae. Symptoms include purulent discharge, dysuria, and frequency, and if left untreated, can lead to infertility.
Herpes simplex, another STI, typically presents with ulceration, which is not seen in this patient. Candida albicans, a type of yeast, is an unlikely diagnosis in men and would present with balanitis and white discharge. Chlamydia trachomatis, while similar in presentation, does not show Gram-negative diplococci on microscopy. However, up to 50% of patients with gonorrhoeae may also have coexisting chlamydia infection, so antibiotic regimes should cover both. Ciprofloxacin is effective, but drug-resistant strains of N. gonorrhoeae are emerging, so alternative antibiotics may be necessary.
Finally, Trichomonas vaginalis, an anaerobic protozoan infection, is ruled out by the microscopy result. Accurate diagnosis and differentiation of STIs are essential for effective treatment and prevention of complications.
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This question is part of the following fields:
- Sexual Health
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Question 8
Incorrect
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A teenage patient has been diagnosed with a chlamydial infection following a recent sexually transmitted infection (STI) screen. The patient has agreed to treatment of the infection and has no known allergies, however, you are concerned about compliance.
Which of the following would be most appropriate?Your Answer: Doxycycline
Correct Answer: Azithromycin
Explanation:Treatment Options for Chlamydia: A Comparison of Antibiotics
Chlamydia is a common sexually transmitted infection caused by the bacterium C.trachomatis. It can be asymptomatic, particularly in females, and if left untreated, can lead to fertility issues and pelvic inflammatory disease. To combat this, national campaigns are encouraging testing and awareness. The recommended treatment for chlamydia is azithromycin, which is safe for patients with a penicillin allergy and has a short course of treatment. Erythromycin is an alternative for pregnant patients, while doxycycline and ofloxacin have similar efficacy but concerns regarding compliance and antibiotic resistance. Amoxicillin is only recommended for use in pregnancy or breastfeeding. It is important to consider the appropriate antibiotic based on the patient’s clinical situation and therapeutic indications.
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This question is part of the following fields:
- Sexual Health
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Question 9
Incorrect
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A 30-year-old man visits the Urology Clinic after being referred by his GP due to a painful genital ulcer. The patient reports that the skin lesion has evolved over time, initially presenting as pustular after he returned from South America. During the examination, you observe that the ulcer base is filled with a foul-smelling yellow discharge, and there is tender lymphadenopathy on one side upon palpation. What is the probable diagnosis?
Your Answer: Genital herpes
Correct Answer: Chancroid
Explanation:Differential Diagnosis of Genital Ulcer Disease: A Case of Chancroid
A patient presents with a genital ulcer, which has developed from a papule to a painful ulcer. The lesion is diagnosed as chancroid, a sexually transmitted disease caused by Haemophilus ducreyi. Chancroid is endemic in Asia, South America, and Africa, and typically presents as a single lesion in men and multiple lesions in women. Painful unilateral lymphadenopathy may be present, which can progress to suppurative buboes.
Other possible differential diagnoses include genital herpes, which produces multiple painful and itchy ulcers, and syphilis, which produces a single painless ulcer (chancre) at an early stage. However, due to the patient’s recent travel and the presence of pain, these are less likely diagnoses.
Donovanosis, or granuloma inguinale, is caused by Klebsiella granulomatis and produces multiple nodules that burst into painless ulcers. Inguinal lymphadenopathy is minimal, making this an unlikely differential. Lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis, produces a painless ulcer at the contact site, but the patient’s ulcer is painful. In the second stage of LGV infection, painful lymphadenopathy and bubo development occur.
In conclusion, chancroid is the most likely diagnosis for this patient’s genital ulcer, and other differential diagnoses should be considered based on clinical presentation and travel history.
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This question is part of the following fields:
- Sexual Health
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Question 10
Incorrect
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A sexually active teenager has forgotten two of her combined contraceptive pills. The pills have been missed in the third week of the packet (days 15–21).
What is the most appropriate advice?Your Answer: The most recent pill should be taken. There is no need for extra precautions provided the woman omits the pill-free week and starts the new pack immediately.
Correct Answer: The most recent pill should be taken immediately and continue with the remaining pills. Condoms should be used until seven consecutive pills have been taken and omit the pill-free interval week. Start the new pack.
Explanation:Guidance for Missed Birth Control Pills
When a woman misses a birth control pill, it can be confusing to know what to do next. Here is some guidance for different scenarios:
1. One missed pill: Take the most recent pill immediately and continue with the remaining pills. Use condoms until seven consecutive pills have been taken and omit the pill-free interval week. Start the new pack.
2. One missed pill (less than 24 hours late): Take the missed pill as soon as possible. There is no need for extra precautions provided the woman omits the pill-free week and starts the new pack immediately. Use condoms until seven consecutive active pills have been taken.
3. Two missed pills: Take both missed pills and use extra precautions for the next seven days. Continue the pack as usual.
4. Two missed pills (less than 48 hours late): Take the most recently missed pill as soon as possible. There is no indication for emergency contraception if the preceding seven pills prior to the missed pills have been taken correctly. Use condoms until seven consecutive active pills have been taken after missing tablets. If this is not the case, emergency contraception should be considered.
5. Two missed pills (more than 48 hours late): Do not take the missed pills. Continue the packet as usual but use condoms for the next seven days. Take the most recent pill as soon as possible and use condoms until seven consecutive active pills have been taken.
Remember, it is important to always read the instructions that come with your specific birth control pill and to consult with a healthcare provider if you have any concerns or questions.
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This question is part of the following fields:
- Sexual Health
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