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Unit 4 disease charts > 4.1 > Flashcards

4.1 Flashcards

1
Q

primary infection of HSV 1 causes what in adults

A

tonsillopharyngitis

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2
Q

primary infection of HSV 1 causes what in kids

A

gingivostomatitis

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3
Q

Recurrent infection/reactivation of latent infection in HSV 1 causes

A

herpes labialis (cold sore)

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4
Q

Prodromal symptoms occur how long before grouped vesicles on an erythematous base appear in HSV 1?

A

24 H

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5
Q

test of choice for HSV 1

A

PCR

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6
Q

Most cases of genital herpes are caused by

A

HSV 2

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7
Q

Are ulcers painful or painless in HSV 2

A

painful

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8
Q

test of choice for HSV 2

A

PCR

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9
Q

what does Tzanck smear show for HSV 1, 2, and VZV

A

multinucleated giant cells

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10
Q

severe infection of the brain parenchyma caused by HSV 1

A

HSV encephalitis

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11
Q

most common cause of encephalitis in the US

A

HSV 1

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12
Q

what lobe most commonly undergoes necrosis in HSV encephalitis

A

temporal lobe

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13
Q

focal neurologic findings in HSV encephalitis

A

rapid onset of fever
headache
seizures
alertness changes

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14
Q

What will LP show for HSV encephalitis

A

increased lymphocytes
normal glucose

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15
Q

What is Epstein-barr virus caused by

A

HHV-4

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16
Q

What is another name for Epstein-barr virus

A

Infectious mononucleosis

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17
Q

what cells are infected in Epstein-Barr virus

A

B cells

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18
Q

Main clinical manifestations for infectious mononucleosis

A

fever
fatigue
pharyngitis
lymphadenopathy

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19
Q

is lymphadenopathy most commonly anterior or posterior cervical in infectious mononucleosis

A

posterior cervical

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20
Q

in what infection do we commonly see generalized maculopapular rash if given ampicillin or amoxicillin

A

infectious mononucleosis/epstein-barr virus

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21
Q

What causes cytomegalovirus

A

HHV-5

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22
Q

how is HHV-5 transmitted

A

body fluids
vertical transmission

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23
Q

in what population of people is HHV-5 most common

A

immunocompromised patients

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24
Q

what causes varicella zoster virus

A

HHV-3

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25
Q

area where cervical cells are most likely to become cancerous

A

transformation zone

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26
Q

CIN

A

cervical intraepithelial neoplasia

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27
Q

NILM

A

negative for intraepithelial malignancy

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28
Q

what indicates no epithelial abnormality

A

NILM

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29
Q

ASCUS

A

atypical squamous cells of undetermined significance

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30
Q

cells that display abnormalities more marked charges but no squamous intraepithelial lesions

A

ASCUS

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31
Q

ASCH

A

atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion

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32
Q

mix of high grade squamous intraepithelial lesion and other findings that mimic such lesions

A

ASCH

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33
Q

LSIL

A

low grade squamous intraepithelial lesions

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34
Q

lesions associated with HPV infection

A

LSIL

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35
Q

HSIL

A

high grade squamous intraepithelial lesions

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36
Q

lesions associated with high risk types of HPV

A

HSIL

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37
Q

What HPV strands are associated with high risk types of HPV

A

16
18

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38
Q

at what age do you begin screening for cytology (PAP smear)

A

21 regardless of sexual history

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39
Q

in what population of people should you do annual screening of PAP

A

history of cervical cancer
history of CIN2 or CIN3
HIV+
Exposure to DES (diethylstilbestrol)
Immunocompromised pts

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40
Q

what are the 5 P’s when doing sexual history

A

Partners
Practice
Past History
Protection
Pregnancy Planning

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41
Q

what is chlamydia caused by

A

chlamydia trachomatis

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42
Q

what is the most common overall bacterial cause of STI in the US

A

chlamydia

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43
Q

what is the most specific and sensitive test for C. trachomatis, N gonorrhoeae, M genitalium (vaginal swab or first catch preferred)

A

Nucleic acid amplification

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44
Q

Gram stain for chlamydia

A

greater than or equal to 2 WBCs/hpf and no organisms seen

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45
Q

urinalysis dipstick for chlamydia

A

positive leukocyte esterase or greater than or equal to 10 WBCs/hpf on microscopy

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46
Q

what is the most commonly transmitted sexual infection in the US

A

herpes papilloma virus (HPV)

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47
Q

HPV only infects

A

humans

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48
Q

how is HPV categorized

A

based on epithelial cells it prefers to infect

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49
Q

benign tumors created by some HPV strands

A

papillomas
warts

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50
Q

in some types of HPV infection, the epithelial cell can turn into

A

a koilocyte (usually precancerous)

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51
Q

how do you get HPV

A

contact with infected epithelial cells

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52
Q

risk for HPV

A

-multiple or new sexual partners with HPV
-delivering a baby through infected birth canal

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53
Q

are plantar warts usually painful or painless?

A

usually painful

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54
Q

are skin warts and flat warts painful or painless?

A

usually painless

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55
Q

chronic cutaneous infection which can start out as flat warts and transform into cancer

A

epidermodysplasia verruciformis

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56
Q

warts that tend to be skin colored and have a cauliflower look

A

condylomata acuminata

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57
Q

what HPV types are responsible for the majority of laryngeal papillomatosis and genital warts

A

HPV types 6 and 11

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58
Q

definitive diagnosis of HPV

A

molecular testing of biopsied cells for viral DNA or RNA

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59
Q

treatment for HPV

A

wart removal
immune modifiers (if recurrent)

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60
Q

BEST course for HPV

A

PREVENTION

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61
Q

what bacteria causes gonorrhea

A

neisseria gonorrhoeae

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62
Q

is gonorrhea gram negative or gram positive

A

gram negative, diplococci

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63
Q

gonorrhea can cause septic arthritis — most commonly where?

A

the knee

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64
Q

triad of gonorrhea when it is not arthritis

A

dermatitis
polyarthralgias
tenosynovitis

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65
Q

should nucleic acid amplification be taken at one or multiple sites

A

multiple sites

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66
Q

should urinalysis for chlamydia and gonorrhea be clean catch or first catch

A

first catch

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67
Q

gram stain for gonorrhea

A

gram-negative intracellular diplococci

68
Q

urinalysis or dipstick for gonorrhea

A

positive leukocyte esterase on dipstick or greater than or equal to 10 WBCs/hpf on microscopy

69
Q

what type of agar can be used to diagnose gonorrhea

A

chocolate agar or Thayer-martin medium

70
Q

what is trichomoniasis caused by

A

trichomonas vaginalis

71
Q

what type of bacteria is trichomonas vaginalis

A

flagellated protozoan

72
Q

how is trichomoniasis transmitted

A

SEXUALLY

73
Q

what color will the discharge be in a woman with trichomoniasis

A

copious frothy yellow-green

74
Q

what will you see in the cervix and vagina in trichomoniasis

A

cervical petechiae (punctate hemorrhages) –> strawberry cervix

75
Q

diagnosis of trichomoniasis

A

mobile protozoan trophozoites with a single flagellum
vaginal pH > 4.5 (usually 5-6)

76
Q

what is the vaginal pH in trich

A

> 4.5 (usually 5-6)

77
Q

what is bacterial vaginosis commonly caused by

A

gardnerella vaginalis and anaerobes

78
Q

what bacteria will be decreased in bacterial vaginosis

A

lactobacillus acidophilus

79
Q

is bacterial vaginosis a sexually transmitted infection

A

no

80
Q

in what population of women is bacterial vaginosis most common

A

sexually active women with new or multiple partners

81
Q

what can increase risk of developing bacterial vaginosis

A

douching
recent antibiotic use
cigarette smoking
intrauterine device

82
Q

what percent of women with BV are asymptomatic

A

50-75%

83
Q

main clinical manifestations of BV

A

malodorous vaginal discharge worse after sex and during menses (due to increased pH)

84
Q

does BV cause dysuria, dyspareunia, pruritus, burning, or vaginal inflammation?

A

no, not usually

85
Q

what type of criteria is used to diagnose BV

A

Amsel criteria

86
Q

how much of Amsel criteria is needed to diagnose BV

A

3 of 4

87
Q

what color will discharge possibly be in BV

A

grayish-white

88
Q

Amsel criteria for BV

A

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

89
Q

what is the most reliable predictor of BV

A

clue cells

90
Q

why will we not see many WBCs in BV

A

it is not an inflammatory infection

91
Q

ascending acute or subclinical infection of the UPPER female reproductive tract

A

pelvic inflammatory disease (PID)

92
Q

risk factors for PID

A

multiple sex partners
unprotected sex
prior PID
age 15-25
nulliparous
IUD

93
Q

what is the most common cause of PID

A

chlamydia trachomatis

94
Q

is PID usually caused by a single organism or mixed

A

usually mixed

95
Q

what is the cardinal symptom of PID

A

pelvic or lower abdominal pain

96
Q

is pain often unilateral or bilateral in PID

A

often bilateral in PID

97
Q

is dyspareunia typically present in PID

A

YES

98
Q

what is very suggestive of PID

A

the onset of pain during or shortly after menses

99
Q

what are defining findings on PE in PID

A

uterine, cervical, and/or adnexal tenderness

100
Q

what sign will you see that indicates cervical motion tenderness in PID

A

chandelier sign

101
Q

will you see discharge in PID?

A

yes; PURULENT

102
Q

what 3 things are required for diagnosis of PID

A

abdominal tenderness
cervical motion tenderness
adnexal tenderness

103
Q

what should you always get in female w abdominal pain

A

pregnancy test

104
Q

perihepatitis with hepatic fibrosis, scarring and peritoneal surface of the anterior right upper quadrant in the setting of PID

A

Fitz Hugh-curtis syndrome

105
Q

what percent of women w PID develop Fitz Hugh-curtis syndrome

A

10%

106
Q

major clinical finding in Fitz Hugh Curtis syndrome

A

RUQ pain –> may radiate to right shoulder

107
Q

what will you see on laparoscopy in someone with perihepatitis

A

violin string adhesions on the anterior liver surface

108
Q

will LFTs be elevated in someone with perihepatitis

A

they may be slightly elevated or normal

109
Q

most common causes of postcoital bleeding

A

benign causes

110
Q

most common malignancy causing postcoital bleeding

A

cervical cancer

111
Q

preferred imaging for postcoital bleeding if not found in laboratory testing

A

pelvic ultrasound

112
Q

what are the 3 phases of menstrual cycle

A

follicular phase
ovulatory phase
luteal phase

113
Q

what phase is associated with the first day of menstruation

A

follicular phase

114
Q

what hormones are initially low during the follicular phase

A

estrogen and progesterone

115
Q

low levels of estrogen and progesterone allow what to occur

A

endometrium breaks down and is shed –> bleeding

116
Q

what hormones increase initially during the follicular phase

A

FSH

117
Q

what day do you TYPICALLY ovulate

A

day 14 of cycle

118
Q

we see a surge of what hormones during the ovulatory phase

A

FSH and LH

119
Q

what hormone stimulates egg release during ovulatory phase

A

LH

120
Q

what hormones decrease during the luteal phase

A

LH and FSH

121
Q

what hormone does the corpus luteum produce

A

progesterone

122
Q

what hormones are high during the luteal phase

A

estrogen and progesterone

123
Q

what position is a woman in during pelvic exam

A

modified dorsal lithotomy position

124
Q

is palpation of ovaries in postmenopausal woman normal?

A

NO

125
Q

what is the most frequent positioning of the uterus

A

ante-flexed and anteverted

126
Q

what is oxytocin released from

A

posterior pituitary

127
Q

where is prolactin released

A

anterior pituitary

128
Q

what is the only contraindication for colposcopy

A

active or untreated cervical or vaginal infection

129
Q

what solution is sometimes used during colposcopy and also during loop electrosurgical excision procedure (LEEP)

A

Lugol (iodine containing)

130
Q

Lugol solution to highlight the dysplastic area due to its lack of absorption of the brown solution resulting in a yellow color

A

Schiller’s test

131
Q

what solution is applied after colposcopy to stop bleeding

A

Monsel’s solution or silver nitrate

132
Q

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

A

loop electrosurgical excision procedure (LEEP)

133
Q

what type of gas is used in cervical cryotherapy

A

compressed nitrogen gas

134
Q

what type of virus is HIV

A

a retrovirus

135
Q

how does viral RNA change into DNA in HIV

A

reverse transcriptase

136
Q

acute seroconversion in HIV is also called

A

acute retroviral syndrome

137
Q

what type of symptoms due patients present with during the acute seroconversion phase in HIV

A

flu-like or mononucleosis-like

138
Q

within how many weeks do patients present symptoms of acute seroconversion in HIV

A

2-4 weeks of infection

139
Q

what is the most commonly seen opportunistic infection in HIV

A

oral and esophageal Candidiasis

140
Q

how is AIDS defined as

A

CD4 count < 200 cells/microliter

141
Q

viral RNA levels in early HIV infection

A

usually high ( > 100,000 copies per mL) often in the millions

CD4 count can drop transiently

142
Q

which tends to be lower in early HIV infection: CD4 or CD8

A

CD4 tends to be lower

143
Q

what may be elevated in early HIV infection

A

liver enzymes

144
Q

how do you diagnose suspected early HIV infection

A

combination antigen/antibody immunoassay (screening) + HIV RNA viral load testing (RT-PCR)

145
Q

if the combination antigen/antibody immunoassay (screening) + HIV RNA viral load testing are negative with high suspicion, when should you repeat BOTH tests

A

1-2 weeks

146
Q

after initial negative

negative screening immunoassay + positive HIV RNA suggests

A

early HIV

147
Q

after initial negative

positive HIV screening immunoassay + positive HIV RNA suggests

A

early or established infection

148
Q

after initial negative

after positive HIV screening immunoassay + positive HIV RNA how do you confirm HIV infection

A

confirm with a second test (repeat HIV RNA or serologic test) several weeks later

149
Q

What is used to monitor infectivity and treatment effectiveness in patients diagnosed with HIV

A

HIV RNA viral load

150
Q

can HIV RNA viral load test be positive in the window period

A

YES

151
Q

does further testing need to be done after routine screening antigen/antibody combination HIV-1/2 immunoassay is negative

A

NO

152
Q

Most common symptoms in early/acute seroconversion in HIV

A

fever
fatigue
myalgias

153
Q

which 2 STIs (that we talked about) can present with pharyngeal exudates

A

HSV2
gonorrhea

154
Q

most common cause of acute viral hepatitis in the world

A

Hepatitis E

155
Q

when should you get your first dose of the hepatitis A vaccine

A

12-23 months

156
Q

when should you get your second dose of the hepatitis A vaccine

A

at least 6 months after the first dose

157
Q

how is hepatitis A transmitted

A

fecal-oral transmission

158
Q

how is hepatitis E transmitted

A

contaminated food and water
blood transfusions
vertical transmission (mom to baby)

159
Q

is a bartholin abscess painful

A

yes - it is infected

160
Q

is a bartholin cyst painful

A

no - it is not infected

161
Q

how to diagnose bartholin gland cyst/abscess

A

CBC and culture of the drained fluid

162
Q

most common strands of molluscum contagiousum (MCV)

A

MCV1 (90%)
MCV2

163
Q

prevalence of molluscum contagiosum in patients with HIV

A

18%

164
Q

how is molluscum contagiosum most commonly spread in adults

A

sexual contact

165
Q

describe the papules in molluscum contagiosum

A

firm, dome shaped papules with umbilication

often mistaken for warts

166
Q

patients that are immunocompromised may have what type of molluscum

A

giant molluscum

167
Q

what type of “bodies” do we see on histology for molluscum contagiosum

A

molluscum bodies/Henderson-Paterson bodies

Unit 4 disease charts (9 decks)

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