Case 6:

Question 1

Fitz Hugh Curtis Syndrome=

Answer 1

**perihepatitis (inflammation of the serous/peritoneal coating of liver)

Question 2

Fitz Hugh Curtis Syndrome occurs in the setting of _____

Answer 2

**PID (ABOUT 10% of women) when there’s inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ

Question 3

Fitz Hugh Curtis Syndrome:

-Sx?

Answer 3

RUQ pain, pleuritic pain, may have referral to right shoulder

Question 4

Fitz Hugh Curtis Syndrome:

____ tenderness to palpation on PE

Answer 4

*RUQ

Question 5

Fitz Hugh Curtis Syndrome is associated with _______ and chlamydia

Answer 5

gonorrhea

Question 6

“chandelier sign”

Answer 6

• Cervical motion tenderness
• -classically in the setting of PID

note: pain is supposedly so bad on bimanual exam that a patient reaches up to grab the chandelier on the ceiling

Question 7

Describe the clinical Sx of Primary Syphilis

Answer 7

-single painless chancre, w/ regional adenopathy

Question 8

Describe the clinical Sx of Secondary Syphilis

Answer 8

**rash involving the palms and soles= “money spots”

Question 9

Describe late syphilis/aka tertiary syphilis (findings?)

Answer 9

Symptomatic manifestations involving cardiovascular system or gummatous disease (ie granulomatous disease)

Question 10

When does neurosyphilis arise?

Answer 10

can occur AT ANY TIME during course of infection. +/- asymptomatic meningitis, occular neuritis, Dementia, AMS

Question 11

Syphilis Dx:

Answer 11

VDRL or RPR –> then MUST DO a confirmatory test (pick 1 of the 4 confirmatory (treponemal tests)

**THE USE OF ONLY 1 serologic test is insufficient for dx

Question 12

Syphilis: tx?

Answer 12

PCN G- IM or IV

-alternatives= doxy, or ceftriaxone

Question 13

Gonorrhea:

-S/sx?

Answer 13

asymptomatic, or cervicitis with mucopurulent discharge, pruritis, dysuria

Question 14

Gonorrhea:

dx? which test is needed*

Answer 14

**NAAT (nucleic acid amplification testing) preferred

-Vaginal swab in women and urine in men

Question 15

Gonorrhea:

-tx?

Answer 15

Ceftriaxone 500 mg IM x 1

-If chlamydia coinfection not R/O, add doxycycline 100 mg BID x 7 days

Question 16

Chlamydia:

-S/Sx?

Answer 16

Most asymptomatic, but cervicitis, discharge, dysuria and abnormal vaginal bleeding possible

Question 17

Chlamydia:

-can cause which Sx/conditions in men (list 2)?

Answer 17

can cause epididymitis & chronic prostatitis in men

Question 18

Chlamydia:

dx test?

Answer 18

NAAT (swab for women, **urine test for men)

Question 19

Chlamydia:

tx?

Answer 19

• *Doxycycline & azithromycin both considered 1st line
• -Azithromycin 1g PO x 1
• -Doxycycline 100 mg PO BID x 7 days

Question 20

Herpes:

-S/Sx of primary infection?

Answer 20

can be mild and asymptomatic or have a fever/constitutional symptoms with painful genital ulcers

Question 21

Herpes:

-S/sx of recurrent infxn?

Answer 21

usually unilateral small vesicular or ulcerative lesions. Could have vulvar irritation or fissures.

Question 22

Herpes:
-dx testing includes:
____ culture and _____ smear

Answer 22

**Viral culture w/ fluid from unroofed vesicle (but only about 50% sensitivity), PCR, direct fluorescent antibody, **Tzanck smear , or serologic testing

Question 23

Herpes:

Tzank smear shows _______ cells

Answer 23

**multinucleated giant cells, (low sensitivity and specificity

Question 24

Herpes:

tx?

Answer 24

Lifelong persistence, but acyclovir or valacyclovir used to treat a flare or as suppressive treatment

Question 25

BV:

-Sx? (if symptomatic)

Answer 25

Most asymptomatic.

-If symptomatic: thin off-white vaginal discharge and/or odor with a **fishy smell (worse after sex and with menses)

Question 26

BV:

-dx testing if microscopy available, _____ criteria (__/4 required)

Answer 26

IF microscopy available: **Amsel criteria (3/4 needed)

Question 27

BV:

-list 4 amsel criteria*

Answer 27

• Homogenous thin white/gray discharge that coats vaginal walls
• Vaginal pH >4.5
• Positive whiff-amine test with 10% KOH
• **Clue cells on saline mount, at least 20% epithelial cells

Question 28

BV: tx?

Answer 28

Metronidazole (oral or topical) or clindamycin (oral or topical)

Question 29

Candidiasis:

s/sx?

Answer 29

• *Cottage cheese like/thick white vaginal discharge, intense pruritis
• +/- vulvar burning, dysuria, or dyspareunia.

Question 30

Candidiasis:

-Dx?

Answer 30

**Wet mount shows budding yeast, hyphae. KOH makes it easier to see

Question 31

Candidiasis:

-tx

Answer 31

oral fluconazole x 1 dose (but it interacts with a LOT of drugs) or topical clotrimazole or miconazole (1 day, 3 day, and 7 day options available)

Question 32

Trich:

• s/sx?
• -discharge color?
• -cervix looks ____

Answer 32

Asymptomatic or purulent, malodorous, **greenish yellow thin discharge associated with burning, dyspareunia, pruritis, dysuria, or lower abdominal pain.
***Strawberry cervix. Men more often asymptomatic.

Question 33

Trich:

• dx?
• gold standard test=

Answer 33

Motile trichomonads seen on wet mount.

-NAAT testing= gold standard**

Question 34

Trich: tx?

Answer 34

7-day course of metronidazole or tinidazole

Question 35

DOMESTIC ABUSE:

-Colorado 2017 HB17-1322 states:

Answer 35

• Medical professionals are NO longer required to report most cases of domestic violence to the police
• Patient must be over the age of 18
• **Still required to report for serious bodily injury (like GSW or stab)
• Injuries still need to be documented in the chart as domestic-violence related
• If victim chooses not to speak with police, healthcare workers must refer them to an advocate or counselor who can help them develop a safe plan