Case 6: Flashcards
Fitz Hugh Curtis Syndrome=
**perihepatitis (inflammation of the serous/peritoneal coating of liver)
Fitz Hugh Curtis Syndrome occurs in the setting of _____
**PID (ABOUT 10% of women) when there’s inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ
Fitz Hugh Curtis Syndrome:
-Sx?
RUQ pain, pleuritic pain, may have referral to right shoulder
Fitz Hugh Curtis Syndrome:
____ tenderness to palpation on PE
*RUQ
Fitz Hugh Curtis Syndrome is associated with _______ and chlamydia
gonorrhea
“chandelier sign”
- 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
Describe the clinical Sx of Primary Syphilis
-single painless chancre, w/ regional adenopathy
Describe the clinical Sx of Secondary Syphilis
**rash involving the palms and soles= “money spots”
Describe late syphilis/aka tertiary syphilis (findings?)
Symptomatic manifestations involving cardiovascular system or gummatous disease (ie granulomatous disease)
When does neurosyphilis arise?
can occur AT ANY TIME during course of infection. +/- asymptomatic meningitis, occular neuritis, Dementia, AMS
Syphilis Dx:
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
Syphilis: tx?
PCN G- IM or IV
-alternatives= doxy, or ceftriaxone
Gonorrhea:
-S/sx?
asymptomatic, or cervicitis with mucopurulent discharge, pruritis, dysuria
Gonorrhea:
dx? which test is needed*
**NAAT (nucleic acid amplification testing) preferred
-Vaginal swab in women and urine in men
Gonorrhea:
-tx?
Ceftriaxone 500 mg IM x 1
-If chlamydia coinfection not R/O, add doxycycline 100 mg BID x 7 days
Chlamydia:
-S/Sx?
Most asymptomatic, but cervicitis, discharge, dysuria and abnormal vaginal bleeding possible
Chlamydia:
-can cause which Sx/conditions in men (list 2)?
can cause epididymitis & chronic prostatitis in men
Chlamydia:
dx test?
NAAT (swab for women, **urine test for men)
Chlamydia:
tx?
- *Doxycycline & azithromycin both considered 1st line
- -Azithromycin 1g PO x 1
- -Doxycycline 100 mg PO BID x 7 days
Herpes:
-S/Sx of primary infection?
can be mild and asymptomatic or have a fever/constitutional symptoms with painful genital ulcers
Herpes:
-S/sx of recurrent infxn?
usually unilateral small vesicular or ulcerative lesions. Could have vulvar irritation or fissures.
Herpes:
-dx testing includes:
____ culture and _____ smear
**Viral culture w/ fluid from unroofed vesicle (but only about 50% sensitivity), PCR, direct fluorescent antibody, **Tzanck smear , or serologic testing
Herpes:
Tzank smear shows _______ cells
**multinucleated giant cells, (low sensitivity and specificity
Herpes:
tx?
Lifelong persistence, but acyclovir or valacyclovir used to treat a flare or as suppressive treatment
BV:
-Sx? (if symptomatic)
Most asymptomatic.
-If symptomatic: thin off-white vaginal discharge and/or odor with a **fishy smell (worse after sex and with menses)
BV:
-dx testing if microscopy available, _____ criteria (__/4 required)
IF microscopy available: **Amsel criteria (3/4 needed)
BV:
-list 4 amsel criteria*
- 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
BV: tx?
Metronidazole (oral or topical) or clindamycin (oral or topical)
Candidiasis:
s/sx?
- *Cottage cheese like/thick white vaginal discharge, intense pruritis
- +/- vulvar burning, dysuria, or dyspareunia.
Candidiasis:
-Dx?
**Wet mount shows budding yeast, hyphae. KOH makes it easier to see
Candidiasis:
-tx
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)
Trich:
- s/sx?
- -discharge color?
- -cervix looks ____
Asymptomatic or purulent, malodorous, **greenish yellow thin discharge associated with burning, dyspareunia, pruritis, dysuria, or lower abdominal pain.
***Strawberry cervix. Men more often asymptomatic.
Trich:
- dx?
- gold standard test=
Motile trichomonads seen on wet mount.
-NAAT testing= gold standard**
Trich: tx?
7-day course of metronidazole or tinidazole
DOMESTIC ABUSE:
-Colorado 2017 HB17-1322 states:
- 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
