4.1 Flashcards
primary infection of HSV 1 causes what in adults
tonsillopharyngitis
primary infection of HSV 1 causes what in kids
gingivostomatitis
Recurrent infection/reactivation of latent infection in HSV 1 causes
herpes labialis (cold sore)
Prodromal symptoms occur how long before grouped vesicles on an erythematous base appear in HSV 1?
24 H
test of choice for HSV 1
PCR
Most cases of genital herpes are caused by
HSV 2
Are ulcers painful or painless in HSV 2
painful
test of choice for HSV 2
PCR
what does Tzanck smear show for HSV 1, 2, and VZV
multinucleated giant cells
severe infection of the brain parenchyma caused by HSV 1
HSV encephalitis
most common cause of encephalitis in the US
HSV 1
what lobe most commonly undergoes necrosis in HSV encephalitis
temporal lobe
focal neurologic findings in HSV encephalitis
rapid onset of fever
headache
seizures
alertness changes
What will LP show for HSV encephalitis
increased lymphocytes
normal glucose
What is Epstein-barr virus caused by
HHV-4
What is another name for Epstein-barr virus
Infectious mononucleosis
what cells are infected in Epstein-Barr virus
B cells
Main clinical manifestations for infectious mononucleosis
fever
fatigue
pharyngitis
lymphadenopathy
is lymphadenopathy most commonly anterior or posterior cervical in infectious mononucleosis
posterior cervical
in what infection do we commonly see generalized maculopapular rash if given ampicillin or amoxicillin
infectious mononucleosis/epstein-barr virus
What causes cytomegalovirus
HHV-5
how is HHV-5 transmitted
body fluids
vertical transmission
in what population of people is HHV-5 most common
immunocompromised patients
what causes varicella zoster virus
HHV-3
area where cervical cells are most likely to become cancerous
transformation zone
CIN
cervical intraepithelial neoplasia
NILM
negative for intraepithelial malignancy
what indicates no epithelial abnormality
NILM
ASCUS
atypical squamous cells of undetermined significance
cells that display abnormalities more marked charges but no squamous intraepithelial lesions
ASCUS
ASCH
atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion
mix of high grade squamous intraepithelial lesion and other findings that mimic such lesions
ASCH
LSIL
low grade squamous intraepithelial lesions
lesions associated with HPV infection
LSIL
HSIL
high grade squamous intraepithelial lesions
lesions associated with high risk types of HPV
HSIL
What HPV strands are associated with high risk types of HPV
16
18
at what age do you begin screening for cytology (PAP smear)
21 regardless of sexual history
in what population of people should you do annual screening of PAP
history of cervical cancer
history of CIN2 or CIN3
HIV+
Exposure to DES (diethylstilbestrol)
Immunocompromised pts
what are the 5 P’s when doing sexual history
Partners
Practice
Past History
Protection
Pregnancy Planning
what is chlamydia caused by
chlamydia trachomatis
what is the most common overall bacterial cause of STI in the US
chlamydia
what is the most specific and sensitive test for C. trachomatis, N gonorrhoeae, M genitalium (vaginal swab or first catch preferred)
Nucleic acid amplification
Gram stain for chlamydia
greater than or equal to 2 WBCs/hpf and no organisms seen
urinalysis dipstick for chlamydia
positive leukocyte esterase or greater than or equal to 10 WBCs/hpf on microscopy
what is the most commonly transmitted sexual infection in the US
herpes papilloma virus (HPV)
HPV only infects
humans
how is HPV categorized
based on epithelial cells it prefers to infect
benign tumors created by some HPV strands
papillomas
warts
in some types of HPV infection, the epithelial cell can turn into
a koilocyte (usually precancerous)
how do you get HPV
contact with infected epithelial cells
risk for HPV
-multiple or new sexual partners with HPV
-delivering a baby through infected birth canal
are plantar warts usually painful or painless?
usually painful
are skin warts and flat warts painful or painless?
usually painless
chronic cutaneous infection which can start out as flat warts and transform into cancer
epidermodysplasia verruciformis
warts that tend to be skin colored and have a cauliflower look
condylomata acuminata
what HPV types are responsible for the majority of laryngeal papillomatosis and genital warts
HPV types 6 and 11
definitive diagnosis of HPV
molecular testing of biopsied cells for viral DNA or RNA
treatment for HPV
wart removal
immune modifiers (if recurrent)
BEST course for HPV
PREVENTION
what bacteria causes gonorrhea
neisseria gonorrhoeae
is gonorrhea gram negative or gram positive
gram negative, diplococci
gonorrhea can cause septic arthritis — most commonly where?
the knee
triad of gonorrhea when it is not arthritis
dermatitis
polyarthralgias
tenosynovitis
should nucleic acid amplification be taken at one or multiple sites
multiple sites
should urinalysis for chlamydia and gonorrhea be clean catch or first catch
first catch
gram stain for gonorrhea
gram-negative intracellular diplococci
urinalysis or dipstick for gonorrhea
positive leukocyte esterase on dipstick or greater than or equal to 10 WBCs/hpf on microscopy
what type of agar can be used to diagnose gonorrhea
chocolate agar or Thayer-martin medium
what is trichomoniasis caused by
trichomonas vaginalis
what type of bacteria is trichomonas vaginalis
flagellated protozoan
how is trichomoniasis transmitted
SEXUALLY
what color will the discharge be in a woman with trichomoniasis
copious frothy yellow-green
what will you see in the cervix and vagina in trichomoniasis
cervical petechiae (punctate hemorrhages) –> strawberry cervix
diagnosis of trichomoniasis
mobile protozoan trophozoites with a single flagellum
vaginal pH > 4.5 (usually 5-6)
what is the vaginal pH in trich
> 4.5 (usually 5-6)
what is bacterial vaginosis commonly caused by
gardnerella vaginalis and anaerobes
what bacteria will be decreased in bacterial vaginosis
lactobacillus acidophilus
is bacterial vaginosis a sexually transmitted infection
no
in what population of women is bacterial vaginosis most common
sexually active women with new or multiple partners
what can increase risk of developing bacterial vaginosis
douching
recent antibiotic use
cigarette smoking
intrauterine device
what percent of women with BV are asymptomatic
50-75%
main clinical manifestations of BV
malodorous vaginal discharge worse after sex and during menses (due to increased pH)
does BV cause dysuria, dyspareunia, pruritus, burning, or vaginal inflammation?
no, not usually
what type of criteria is used to diagnose BV
Amsel criteria
how much of Amsel criteria is needed to diagnose BV
3 of 4
what color will discharge possibly be in BV
grayish-white
Amsel criteria for BV
copious, thin homogenous grayish-white vaginal discharge
vaginal pH > 4.5
positive Whiff-amine test when 10% KOH added
greater than or equal to 20% clue cells on saline wet mount, few WBCs, few lactobacilli
what is the most reliable predictor of BV
clue cells
why will we not see many WBCs in BV
it is not an inflammatory infection
ascending acute or subclinical infection of the UPPER female reproductive tract
pelvic inflammatory disease (PID)
risk factors for PID
multiple sex partners
unprotected sex
prior PID
age 15-25
nulliparous
IUD
what is the most common cause of PID
chlamydia trachomatis
is PID usually caused by a single organism or mixed
usually mixed
what is the cardinal symptom of PID
pelvic or lower abdominal pain
is pain often unilateral or bilateral in PID
often bilateral in PID
is dyspareunia typically present in PID
YES
what is very suggestive of PID
the onset of pain during or shortly after menses
what are defining findings on PE in PID
uterine, cervical, and/or adnexal tenderness
what sign will you see that indicates cervical motion tenderness in PID
chandelier sign
will you see discharge in PID?
yes; PURULENT
what 3 things are required for diagnosis of PID
abdominal tenderness
cervical motion tenderness
adnexal tenderness
what should you always get in female w abdominal pain
pregnancy test
perihepatitis with hepatic fibrosis, scarring and peritoneal surface of the anterior right upper quadrant in the setting of PID
Fitz Hugh-curtis syndrome
what percent of women w PID develop Fitz Hugh-curtis syndrome
10%
major clinical finding in Fitz Hugh Curtis syndrome
RUQ pain –> may radiate to right shoulder
what will you see on laparoscopy in someone with perihepatitis
violin string adhesions on the anterior liver surface
will LFTs be elevated in someone with perihepatitis
they may be slightly elevated or normal
most common causes of postcoital bleeding
benign causes
most common malignancy causing postcoital bleeding
cervical cancer
preferred imaging for postcoital bleeding if not found in laboratory testing
pelvic ultrasound
what are the 3 phases of menstrual cycle
follicular phase
ovulatory phase
luteal phase
what phase is associated with the first day of menstruation
follicular phase
what hormones are initially low during the follicular phase
estrogen and progesterone
low levels of estrogen and progesterone allow what to occur
endometrium breaks down and is shed –> bleeding
what hormones increase initially during the follicular phase
FSH
what day do you TYPICALLY ovulate
day 14 of cycle
we see a surge of what hormones during the ovulatory phase
FSH and LH
what hormone stimulates egg release during ovulatory phase
LH
what hormones decrease during the luteal phase
LH and FSH
what hormone does the corpus luteum produce
progesterone
what hormones are high during the luteal phase
estrogen and progesterone
what position is a woman in during pelvic exam
modified dorsal lithotomy position
is palpation of ovaries in postmenopausal woman normal?
NO
what is the most frequent positioning of the uterus
ante-flexed and anteverted
what is oxytocin released from
posterior pituitary
where is prolactin released
anterior pituitary
what is the only contraindication for colposcopy
active or untreated cervical or vaginal infection
what solution is sometimes used during colposcopy and also during loop electrosurgical excision procedure (LEEP)
Lugol (iodine containing)
Lugol solution to highlight the dysplastic area due to its lack of absorption of the brown solution resulting in a yellow color
Schiller’s test
what solution is applied after colposcopy to stop bleeding
Monsel’s solution or silver nitrate
type of treatment to remove precancerous cells from the cervix utilizing a small wire loop that is attached to a low-voltage, high-frequency alternating electrical current
loop electrosurgical excision procedure (LEEP)
what type of gas is used in cervical cryotherapy
compressed nitrogen gas
what type of virus is HIV
a retrovirus
how does viral RNA change into DNA in HIV
reverse transcriptase
acute seroconversion in HIV is also called
acute retroviral syndrome
what type of symptoms due patients present with during the acute seroconversion phase in HIV
flu-like or mononucleosis-like
within how many weeks do patients present symptoms of acute seroconversion in HIV
2-4 weeks of infection
what is the most commonly seen opportunistic infection in HIV
oral and esophageal Candidiasis
how is AIDS defined as
CD4 count < 200 cells/microliter
viral RNA levels in early HIV infection
usually high ( > 100,000 copies per mL) often in the millions
CD4 count can drop transiently
which tends to be lower in early HIV infection: CD4 or CD8
CD4 tends to be lower
what may be elevated in early HIV infection
liver enzymes
how do you diagnose suspected early HIV infection
combination antigen/antibody immunoassay (screening) + HIV RNA viral load testing (RT-PCR)
if the combination antigen/antibody immunoassay (screening) + HIV RNA viral load testing are negative with high suspicion, when should you repeat BOTH tests
1-2 weeks
after initial negative
negative screening immunoassay + positive HIV RNA suggests
early HIV
after initial negative
positive HIV screening immunoassay + positive HIV RNA suggests
early or established infection
after initial negative
after positive HIV screening immunoassay + positive HIV RNA how do you confirm HIV infection
confirm with a second test (repeat HIV RNA or serologic test) several weeks later
What is used to monitor infectivity and treatment effectiveness in patients diagnosed with HIV
HIV RNA viral load
can HIV RNA viral load test be positive in the window period
YES
does further testing need to be done after routine screening antigen/antibody combination HIV-1/2 immunoassay is negative
NO
Most common symptoms in early/acute seroconversion in HIV
fever
fatigue
myalgias
which 2 STIs (that we talked about) can present with pharyngeal exudates
HSV2
gonorrhea
most common cause of acute viral hepatitis in the world
Hepatitis E
when should you get your first dose of the hepatitis A vaccine
12-23 months
when should you get your second dose of the hepatitis A vaccine
at least 6 months after the first dose
how is hepatitis A transmitted
fecal-oral transmission
how is hepatitis E transmitted
contaminated food and water
blood transfusions
vertical transmission (mom to baby)
is a bartholin abscess painful
yes - it is infected
is a bartholin cyst painful
no - it is not infected
how to diagnose bartholin gland cyst/abscess
CBC and culture of the drained fluid
most common strands of molluscum contagiousum (MCV)
MCV1 (90%)
MCV2
prevalence of molluscum contagiosum in patients with HIV
18%
how is molluscum contagiosum most commonly spread in adults
sexual contact
describe the papules in molluscum contagiosum
firm, dome shaped papules with umbilication
often mistaken for warts
patients that are immunocompromised may have what type of molluscum
giant molluscum
what type of “bodies” do we see on histology for molluscum contagiosum
molluscum bodies/Henderson-Paterson bodies
