GU Suvery Exam 2 Part 2 Flashcards
1
Q
What are 4 causative agent for prostatitis?
A
- E coli
- Klebsiella
- NG
- CT
2
Q
what is an anoscopic?
A
specimen collection for HSV, NG, CT, syphilis
3
Q
What is another name for condyloma accuminata?
A
HPV
4
Q
what are 4 main ways HPV infection can present?
A
- visible genital warts
- subclinical infection
- oropharyngeal infection
- anal infection
5
Q
describe the genital warts assoc w/ HPV?
A
- raised/flat; single/multiple; small/large; cauliflower-like
- most often painless; can cause itching, irritation, bleeding
6
Q
are genital warts most often painless?
A
yes
7
Q
what is the subclinical infection of HPV implicated in
A
Implicated in the risk for some vaginal, vulvar, anal and penile squamous cell cancers
8
Q
HPV and anal infection increases the risk for which cancer by 2/100k year?
A
anal cancer
9
Q
what is the increase risk for MSM for anal cancer and HPV?
A
20xs increased
10
Q
what is the most common sx for anal infection of HPV?
A
• m/c sx genital warts
Anal d/c, bleeding, itching, pain, pressure or lesionsiv
Grayish hyperpigmented patches of HGAIN
11
Q
what are the CDC goals of tx for HPV?
A
- remove visible warts
- tx annoying sx
- EDUCATE SAFER SEX
12
Q
Visible HPV Treatment Options?
A
- Cryotherapy (liquid nitrogen)
- Podofilox/podophylin
- Trichloracetic acid (TCA)
- Electrocautery
- Laser therapy
13
Q
how is subclinical HPV infections generally diagnosed?
A
- Most often diagnosed on Pap smear
* Monitor for precancerous changes
14
Q
4 DDX for genital ulcer dz?
A
- # 1 Herpes simplex virus
- # 2 Syphilis
- # 3 Chancroid (Haemophilus ducreyi)
- # 4 Lymphogranuloma venereum (LGV)-CT
15
Q
Do condoms prevent spread of HSV 1 & 2?
A
condoms do not necessarily prevent infection
16
Q
When does most HSV spread?
A
asx viral shedding spreads most HSV (usually before a breakout)
17
Q
What are the 3 distinct syndromes of HSV?
A
- primary herpes
- first episode non-primary herpes
- recurrent herpes
18
Q
describe primary herpes
A
the first infection with either HSV 1 or 2
19
Q
describe first episode non-primary herpes?
A
initial genital infection in a patient who has already experienced infection with the other HSV type
20
Q
describe recurrent herpes?
A
reactivation with either virus type
21
Q
What is the most severe and longest duration sx form?
A
genital HSV: primary herpes
22
Q
What is the classic progression of genital HSV?
A
- erythematous papule
- vesicle
- pustule
- ulceration (most painful-increased with moisture)
- encrustation
23
Q
what are some systemic sx of genital herpes?
A
fever, malaise, arthralgia, headache
24
Q
What is the average time from sexual contact to onset of sx and lesions of genital HSV?
A
4 days, range is 2-20 days
25
who transmits most of the HSV infections?
persons w/o sxs
26
what are prodromal sxs for HSV?
local paresthesias, itching, pain
27
What are some triggers for HSV breakouts?
stress, fatigue, intercourse, menstrauation, diet/lifestyle, menopause
28
what is the lab dx for HSV?
viral culture
29
what test can be done if only in pustular stage for HSV?
tzank smear, antigen detection tests
30
what is herpes on the hand called?
whitlow
31
HSV of the eye can cause?
keratitis (inflammed cornea- usually unilateral)
blepharitis
keratoconjunctivitis
32
goals of HSV treatment?
* Prevent acquisition of other STI’s, transmission of HSV, and reinocculation
* Reduce pain
* Reduce severity and duration of outbreaks
* Reduce reoccurrence rate
* LOWER VIRAL SHEDDING
33
what is the organism for syphilis?
spirochete
1. treponema pallidum
2. blood born pathogen
34
Where can syphilis infect?
capable of infecting almost any organ and system
35
what is the syphilis progression?
•A syphilis infection can spread through the bloodstream to all parts of the body
36
how does syphilis spread in the body?
via bloodstream
37
How many stages are there in the syphilis progression?
4 stages if not treated, usually extends over many years to the point of affecting behavior
38
what can the last stage of syphilis cause?
heart dz, brain damage, spinal cord damage, blindness and death
39
what are the 4 stages of syphilis
1. primary
2. secondary
3. latent (hidden) stage
4. tertiary (late) stage
40
which lesion is associated with primary syphilis?
chancre
41
when does a chancre usually occur?
within 3 weeks
42
is primary syphilis highly contagious?
YES
43
What is a painless ulcer with clean base?
Chancre
44
what do the borders of a chancre look like?
firm indurated borders
45
where can chancre occurs?
anywhere on the body
46
What stage is the Great Mimicker?
secondary syphilis
47
when does secondary syphilis occur?
•2-8 weeks after chancre pts often develop a RASH
48
symptoms that occurs once syphilis has spread through the body?
–A fever of usually less than 101 °F(38 °C).
–A sore throat.
–A vague feeling of weakness or discomfort throughout the body.
–Weight loss
–Patchy hair loss, especially eyebrows, eyelashes, & scalp.
–Lymphadenopathy
–Nervous system symptoms of secondary syphilis: neck stiffness, headaches, irritability, paralysis, unequal reflexes, and irregular pupils.
49
Where would a rash of secondary syphilis occur?
•Diffuse, macular, papular, combinations
*•palms •soles*
•Patterned Hair loss
50
what defines the latent stage of syphilis?
* If untreated, an infected person will progress to latent stage
* After secondary-stage rash goes away, no symptoms = latent period; may be as brief as 1 year or range from 5 to 20 years.
51
Is a person contagious during latent stage of syphilis?
•A person is contagious during early part of latent stage & may be contagious even when no symptoms are present.
52
what is the most destructive stage of syphilis?
tertiary late stage
53
what are the complication of tertiary late stage syph?
–Gummata large sores inside the body or on skin.
–Cardiovascular affects heart & blood vessels.
–Neurosyphilis affects brain or related structures
54
How to dx syphilis?
```
•Screening antibody testing/VDRL/RPR
–for non-specific ‘reagin’ antibody
–screening test (false positives common)
•More specific / confirmation testing
–flourescent treponemal antibody absorption (FTA- ABS), microhemagglutination test (MHA-TP)
–To confirm screening tests
```
55
what bacterium is associated with a chancroid?
STI caused by H. ducreyi
56
what does H ducreyi cause?
chancroids- ulcers on genitals and are associated with inguinal lymphadenitis
57
what can form if a chancroid affects lymph nodes?
abscess formation
58
are chancroids painful?
yes
59
what causes lymphogranuloma venereum (LGV)?
specific strain of chlamydia
60
where is the highest LGV?
•incidence is highest among sexually active people living in tropical or subtropical climates
61
what is the first symptom of LGV?
small, painless pimple or lesion occurring on penis or vagina. often unnoticed --> lymph nodes
62
another name for crab louse?
pediculosis pubis and pthirus pubis
63
How is crab louse transmitted by?
1. sexual contact
2. shared bedding
3. shared clothing
64
For how long can untreated crab louse ova can live on fomites?
for a month
65
how can you prevent the spread of STIs?
– Abstinence
– Limit number of sex partners.
– Use a male or female condom.
– Carefully wash genitals after sexual relations.
– If infection is suspected, avoid any sexual contact and visit local STI clinic, hospital, doctor.
– Notify all sexual contacts immediately so they can obtain examination and treatment.
66
what is the tx of perimenopause determined?
Treatment determined by severity of symptoms and impact on QOL
67
what is a marker of perimenopause?
rising FSH
68
define menopause?
1 year since last spontaneous menstrual period
69
typical are for menopause?
around 50 YO
70
what age is premature menopause?
<40 YO
71
what is surgical menopause?
bilateral oophorectomy
72
in 2015 what % of US women will be menopausal?
50%
73
what are menopausal symptoms due to?
decreased estrogen
74
Early changes associated with normal menopause estrogen loss?
hot flushes (75%), insomnia, irritability, mood changes, low libido, abnormal bleeding
75
Intermediate changes associated with normal menopause estrogen loss?
vaginal atrophy, urinary incontinence, skin atrophy, hair thinning, facial hair
76
Late changes associated with normal menopause estrogen loss?
Osteoporosis, CAD, Alzheimer’s dementia, colon cancer, age-related macular degeneration, insulin resistance
77
Hot flashes/vasomotor instability?
Dysfunction of central thermoregulatory function due to decreasing estrogen Increased norepinephrine/decreased serotonin perspiration and vasodilation sensation of heat starting in chest rising to head
78
PAP screening guidelines?
every 3 yr 21-65 y.o. (or up to 5 yrs c HPV testing 30-65 yo) uspstf 2012
79
Screening mammogram guidelines?
Biennial screen 50-74 yo
80
Colonoscopy screening?
(start @ 50*)
Annual screening with high-sensitivity fecal occult blood testing
Sigmoidoscopy every 5 years, with high-sensitivity fecal occult blood testing every 3 years
Screening colonoscopy every 10 yearsuspstf 2008
81
DEXA guidelines?
DEXA (bone density) (start @ 65*)
82
goal of menopause tx?
1. Symptom Relief/ improve quality of life
hot flashes, night-sweats, insomnia, moods, anxiety, irregular bleeding, vaginal dryness, low libido, etc.
2. Disease prevention and treatment
Heart disease
Osteoporosis
Insulin resistance & diabetes
Weight gain
Alzheimer's
Cancer (which increase in 50’s? Breast, ovarian, colorectal, endometrial)
Macular degeneration
83
levels of intervention for menopause?
1-Diet, Exercise, Stress Management
2-Nutritional Supplementation, Acupuncture
3-Botanicals (Chinese or Western)
4-HRT
5-Other pharmaceuticals (SSRI’s, Fosamax, Lipitor)
84
if HRT is used when should it be used?
used early menopause
85
ET?
estrogen therapy (no uterus)
86
EPT/HRT?
estrogen progesterone therapy (uterus)
87
CHD screening increased risk with ?
HDL?
LDL?
```
HDL <35
LDL>130
pt w/o CHD and <1 risk factor
LDL 100-130
pt w/o CHD but >2 risk factors
*HDL>50
negative risk factor
```
88
what is procidentia?
prolapse or falling down, pelvic prolapse
89
cystocele?
protrusion of bladder
90
urethrocele?
protrusion of urethra
91
rectocele?
rectum protrusion
92
enterocele?
intestine protrusion
93
predisposing factors for uterine prolapse?
multiparous women, pelvic floor defects d/t childbirth, partial pudendal and perineal neuropathies associated with labor, constipation, menopause, genital atrophy, obesity, smoking
94
what is the #1 sxs of cystocele?
* Incontinence*
| - often causes no sx "something is falling out"
95
what is the most common complaint of rectocele?
constipation or the need to apply digital pressure in the vagina in order to defecate
96
what are typical sxs of enterocele?
typical asxs, can have vaginal pressure and aching discomfort
97
where does the enterocele herniate to?
into the rectovaginal septum
98
what is the most common presenting sx for urethrocele?
vaginal bleeding
99
what is observed upon examination of an urethrocele?
round doughnut-shaped mucosa is obserbed protruding from the urethral opening
100
Main 3 tranmission of HIV?
1. sexual contact
2. contaiminated blood
3. donor tissue, mother to child
101
7 body fluids where HIV is detected?
1. Blood
2. Semen & pre-seminal fluid
3. Vaginal fluid
4. Breast milk
5. Sweat
6. Saliva
7. Tears
102
5 bodily fluids that *transmit* HIV?
1. Blood
2. Semen & pre-seminal fluid
3. Vaginal fluid
4. Breast milk
5. other body fluids containing blood
103
5 routes of HIV transmission?
1. Vagina
2. Rectum
3. Mouth
4. Urethra
5. Inside of eyelids
104
who is more likely to get HIV a female negative receiver or giver
female receiver
105
What is the screening test for HIV infection
ELISA
106
what is the confirmatory test for HIV?
Western blot
107
What does the ELISA detect?
antibodies
108
What is the 6 months window period
- screening detect antibodies not virus
- so the drawback of the antibody test is the "window" period: time it takes to produce antibodies after transmission
- during this period before antibodies are produced, one can be infected with HIV and can infect other, but still test negative on HIV antibody test
109
Can you have HIV and test negative on an antibody test like ELISA?
yes, if you are within the 6m window period, newer tech allows detection of lower antibody levels, can ID them between 3-5 weeks in most individuals
110
what is AIDS?
CD4+/T4 cells <200 cu mm
| or onset of HIV-associated dz
