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ENRP Exam 1 > Gynecologic And Pregnancy Related Infections Dr. Straudinger > Flashcards

Gynecologic And Pregnancy Related Infections Dr. Straudinger Flashcards

1
Q

Thin white discharge coming from vagina + no itching

A

Bacterial Vaginosis, + check preg and chlamydia/ Gonorrhea

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2
Q

How to test for BV, candida, Trichomonasis

A

Wet Mount, checking pH = Vaginitis

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3
Q

How to test for Chlamydia, Gonorrhea, Trichomonasis

A

NAAT, PCR (endocervical swab, vaginal swab, urine)

Trichomonasis best seen on Vaginal swab or urine

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4
Q

Saline wet mount, vaginal epithelial cells with clue cells
+ vaginal discharge placed on slide and add KOH = smells fishy
Ph = over 4.5 (high)

A

BV

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5
Q

BV 3 of the 4 must be present

A
  1. Homogenous thin grey/white discharge
  2. Ph over 4.5
    • Whiff test
  4. Clue cells
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6
Q

BV increased by and how common

A 
Sexual activity (can come with STIs)
= the MOST common in child bearing age
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7
Q

Douching is what

A

Vaginal rented with antiseptic or vinegar = increase BV risk

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8
Q

BV is seen in who

A

minorities and smoking

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9
Q

Normal bacteria in vagina and BV bacteria

A
  1. Lactobacilli = make lower pH, aerotolorant, gram- bacilli

2. Coccobacilli = like higher pH made form sex, gram + (clue cells) = Gardnerella Vaginalis

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10
Q

Gardenerella Vaginalis does what in the vagina

A

Creates BV
= makes biofilm for other bacteria to grow
= all the bacteria combined make the malodorous amine smells

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11
Q

BV 3 tx

A
  1. Metronidazole 2 x day, 7 days (500mg) = inhibit dna synthesis, deplete thiols
  2. Tinidazole = inhibits dna synthesis
  3. Clindamycin = inhibit 50s ribosome translation
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12
Q

Metronidazole and Tinidazole are activated by and their active form kills what

A

Nitroreductase , kills Bacteria BV, Trichomonasis

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13
Q

Metronidazole + Tinidazole side effects

A
  1. V, flushing, HA (with alcohol)
  2. Seizures, ataxia, Dizziness
  3. General : N, anorexia, Bloating, Cramping
    = majority of drug eliminated in urine
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14
Q

Clindamycin (Lincosamine)

  1. Used for
  2. Kills what
  3. Used for
A
  1. Allergic to penicillin
  2. Gram + and Anaerobes + Group A strep (Strep throat) —-> B-lactamase making
  3. Toxic shock syndrome, PID, decrease PROM in women with BV**, tx MERSA also
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15
Q

Clindamycin side effects

A
  1. C. Diff overgrowth (Psudomembranous colitis)

2. Actively transported to Abscesses (not penetrating CSF though) = goood thing

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16
Q

Candida look like what on the external

A

Red and itchy vagina , thick cottage discharge, no redness on cervix

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17
Q

Candida have what tests

A
  1. KOH whiff test is negative however on wet mount + KOH= make final elements more visible, pseudohyphae
  2. PH is normal and low (under 4.5)
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18
Q

Normal pH in vagina

A

3.8-4.5

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19
Q

Risk of Candida

A

DM, Imunosuppressed, High Estrogen, ABs used

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20
Q

Candida albicans is most common what is another candida that can infect

A

Candida Glabrata

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21
Q

Candida can do what after long overgrowth

A

Invasion of squamous cells causing symptomatic disease

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22
Q

3 over the counter topical creams for Candidiasis

A
  1. Clotrimazole
  2. Miconazole
  3. Tioconazole
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23
Q

3 prescriptions topical creams for Candidiasis

A
  1. Terconazole

2. Butoconazole

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24
Q

1 oral 3 prescription for Candidiasis

A

Fluconazole

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25
Q

Fluconazole

  1. MOA
  2. Warnings
A
  1. Destroy fungi by inhibiting lanosterol —> Esgosterol by stickign to the 14a- demethylasa (disrupts the cell membrane*)
  2. Serious birth defects in pregnancy + AVIOD with Erythromycin = cardiotoxicity
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26
Q

Fluconazole and other azoles can cause what side effects

A
  1. Prolongation of QT interval (tornado de pointes) (if taken with Amiodarone or other QT prolongation drugs)*
  2. Cardio toxic if taken with erythromycin *
  3. Renal dysfunction should be with caution*
  4. Not in pregnancy*
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27
Q

Fluconazole inhibits

A

CYP3A4

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28
Q

Trichomonasis sx

  1. Sx
  2. Tests you see
A
  1. Bleeding after sex, itching, dysuria, pain with sex, thin green foul smelling discharge
  2. Cervix is strawberry (punctuate hemorrhage), red vulva and vagina,

= saline wet mount —> flagellated Protozoa, motile (oval shape), pH if over 4.5, KOH whiff test is +, many WBCs

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29
Q

Trichomonasis increases risk of what and associated with and how common

A

Most common NONVIRAL STI
= HIV and HPV
= increased risk of HIV due to cervical hemorrhages , can lead to carcinoma

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30
Q

Trichomonasis is how big and survival NTD likes infecting what

A

2 RBCs, only in humans (pear shaped with flagella) protozoan
= infects Squamous cells especially in urinary tracts , and eats bacteria
= does not for cysts

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31
Q

TX Trichomonasis how 2 drugs

+ what do you need to do when treating

A

1.Metronidazole ** 1st
2. Tinidazole
= must treat all sexual partners
= test 2weeks to 3 months after tx for cure

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32
Q

When taking metronidazole and trinidazole for Trichomonasis what do you need to tell patient

A

Avoid alcohol

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33
Q

Neisseria Gonorrhea and Chlamydia

  1. SX
  2. Tests you see what
A
  1. Thick mucoid discharge, pain sex, vaginal bleeding after sex
    + Normal external genitalia, cervix is RED + purulent discharge
    2.
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34
Q

Cervicitis

  1. Sx and things you see
  2. Cervix is
  3. Most common
A
  1. Redness, mucopurulent discharge from cervix
  2. Spotting or bleeding after sex, dysuria
  3. Chlamydia Gonorrhea, Trichomonasis, HSV, Mycoplasma
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35
Q

Neisseria Gonorrhea

  1. What type of bacteria
  2. Grows on
  3. virulence factor
A
  1. gram - diplococcus
  2. Chocolate agar
  3. Pili adherence
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36
Q

Chlamydia Trachomatis
1, what type of bacteria
2. Dx how

A
  1. Gram - tiny obligate intracellular

2. Not on gram stain, NEED PCR ( Elementary body and Reticulate Body_

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37
Q

Mycoplasma Genitalia

  1. What type
  2. Causes what
A
  1. NO cell wall bacteria
  2. Non-gonococcal urethritis , cervicitis
    = SMALLEST SIZE
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38
Q

How to treat Gonorrhea + Chlamydia when PCR results have not come back

A
  1. Ceftriaxone IM injection

2. Azithromycin oral (Doxycycline can be used if allergy to Azithromycin)

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39
Q

Cervicitis 3 drugs used to treat and their MOA

A
  1. Ceftriaxone (3rd gen, Cell wall synthesis, inhibit B-lactam) IM
  2. Azithromycin (Macrolide AB, 50S ribosome inhibitor)
  3. Doxycycline (Tetracycline AB, 30S ribosome inhibitor)
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40
Q

Ceftriaxone
1. Given how
2, excreted how + good thing about it
3. Side effects

A
  1. IM going through the CSF
  2. Bile + longest HL
  3. Cholestasis + bilirubin displacement, jaundice in neonates
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41
Q

Azithromycin

  1. MOA
  2. Given how
  3. Side effects
A
  1. 50s ribosome inhibitor
  2. IM And oral with empty stomach, excreted in bile
  3. GI upset, ABD pain
42
Q

Doxycycline
1MOA
2. Given how
3. Side effects *

A
  1. 30S ribosome inhibition
  2. oral
  3. NOT IN PREGNANCY*, category D drug
43
Q

PID

  1. SX
  2. Tests say what
A
  1. Thick mucoid discharge + Pain sex, bleeding after sex, FEVER, lower PELVIC PAIN moderate to severe
  2. Normal external genitalia, red cervix with purulent discharge + Cervical Motion Tenderness = CHANDELIER SIGN
44
Q

CHANDELIER SIGN, is done how, means what, do what then

A

Cervical motion tenderness 2 fingers palpating Cervix and other hand above pubic bone palpating down = pt lifts butt off in the air in pain
= PID
= order US

45
Q

What causes PID

A

Gonorrhea or chlamydia or other STIs + BV

46
Q

PID can cause what inflammation

A

Inflammation of Pyrosalpinx + tube-ovarian abscess (fallopiana and ovarian both sides)

47
Q

Tubo-ovarian abscess is what and sx, can spread to cause what

A
  1. Adenexal mass, fever, high WBCs, ABD-pelvic pain (complication of PID)
    2 can causes many adhesions all over ovaries and Fallopian tubes
  2. Fitz-Hugh- Curtis Syndrome
48
Q

Fitz-Hugh- Curtis Syndrome

  1. SX
  2. Happens from
  3. Can lead to
A

Peritoneal inflammation, perihepatitis, Acute severe ABD pain, fever, N/V,
= disseminated infection , gonococcal septic arthritis
= infertility, ectopic, GI obstruction

49
Q

Gonorrhea and chlamydia can cause what to neonates

A
  1. Gonococcal ophthalmia neonatorum (blindness + redness + discharge)
  2. Chlamydia : Neonatal inclusion conjunctivitis (blindness + redness + discharge)
50
Q

PID tx 2 + tx if complicated with abscess or other problem OUTPATIENT

A
  1. Ceftriaxone + Doxycycline

2. Add Metronidazole if complicated

51
Q

PID tx 2 + if pregnant INPATIENT

A
  1. Doxycycline + Cefoxitin OR Doxycycline + Cefotetan

2. Clindamycin + Gentamicin (pregnant)

52
Q

Cefoxitin + Cefotetan

  1. MOA
  2. Advantage over PNC
  3. Side effects
A
  1. 2 gen cephalosporin, inhibit cell wall
  2. More resistance to B-lactam, chemical versatility , broad spec
  3. GI probs, renal toxic, hepatotoxic, thrombocytopenia, neurotoxic
53
Q

Cephalosporin gen1, gen2, gen3

A
  1. Gen1 : gram + , strep pneumonia
  2. Gen2 : broad spec
  3. Gen3 : gram - , strep pneumonia
54
Q

Gentamycin

  1. MOA
  2. Side effects
  3. Not go to
A
  1. 30S Ribosome inhibitor
  2. Category D , NOT good for pregnancy unless needed, renal toxic, ototoxic, NMJ toxic* BLACK BOX
  3. Does it go to CNS or eyes
55
Q

Genital Herpes

  1. SX of
  2. PE
  3. Cause of this
  4. Types of lesions
A
  1. Genital sores (painful stinging + Itchy) fevers HA, dysuria ,
  2. Vulva scattered small shallow vesicles + ulceration , tender + LAD bilaterally
  3. HSV
  4. Early = vesicles red, Later = shallow raised edges
56
Q

Chancroid

  1. Caused by
  2. Lesions
  3. Pain or no and how many + LAD
  4. Other sx
A
  1. H. Ducreyi
  2. clerks purulent base, no indurated, ragged edges
  3. Painful, many, LAD boboes
  4. No other constitutional sx
57
Q

Syphilis

  1. Caused by
  2. Lesions
  3. Pain or no and how many + LAD
  4. Other sx
A
  1. T. Pallidum
  2. Ulcer/chancre, indurated, demarcated edges
  3. NO pain, only 1 + LAD in late primary stage
  4. Secondary syphilis has constitutional sx
58
Q

LGV (Lymphogranuloma Venereum)

  1. Caused by
  2. Lesions
  3. Pain or no and how many + LAD
  4. Other sx
A
  1. C. Trachomatis L1, L2, L3
  2. Early = papule, Late = ulcer small shallow
  3. NO PAIN + only 1, LAD present
  4. Constitutional sx in secondary LGV
59
Q

Granuloma Inguinale (Donovanosis)

  1. Caused by
  2. Lesions
  3. Pain or no and how many + LAD
  4. Other sx
A
  1. K. Granulomais
  2. Highly vascular ulcer beefy red
  3. NO Pain, + variable number of them, NO LADs,
  4. No constitutional sx
60
Q

HSV can also present as and latency

A

Latency on sacral ganglia

= left LAD and left labia vesicles

61
Q

HSV

  1. Type of virus
  2. 2 types
  3. Pap smear shows
  4. TR
A
  1. DNA virus
  2. Orofacial HSV1, Genital HSV2
  3. Molding, Multinucleated, Margination = Pap smear
  4. Vertical transmission + by fluids
62
Q

HSV TX

A
  1. Acyclovir = stopes DNA lengthening, STOP replications , resistance = low viral thymidine kinase
  2. Famciclovir
  3. Valacyclovir
    = within 72 hr of lesions
63
Q

Primary syphilis sx
Secondary syphilis sx
Tertiary syphilis sx

A
  1. Primary = PAINLESS chancre, after 3-6weeks
  2. Secondary = 6 weeks after Condyloma Lata + macular red rash (palms + soles), patchy hair loss, LAD, organ probs
  3. 6 years after, Gummatous Lesions skin and bone (forehead, onside mouth….) , Thoracic Aoritc Aneurysm
64
Q

Neuro syphilis sx

A

Loss of vibration and pain and temperature sense below lesion + - Rombergs,

65
Q

Staying and how syphilis looks

A

Corkscrew organism on silver stain, spinning moving , lymphoplasmacytic infiltrate, GRAM -

66
Q

TESTIG for syphilis

A
  1. Non-Treponemal screeenign test : VDRL, RPR
  2. Treponemal DX Test : FTA-ABS, if above is +
  3. Direct Specimen from tissue = PCR*, or silver stain
67
Q

TX Syphilis 2 + Neurosyphillis tx

A
  1. Penicillin G = Beta-Lactam AB (Benzathine PNC) = safe in preg , gram - and gram + ( Amoxicillin + Flucoxicillin , inhibit cell call bacterial)
  2. Doxycycline if PNC allergy
  3. Aqueous crystalline PNC G + Procaine PNC G / probenecid
68
Q

Chancroid is found where

A

Africa, Latin America, Southeast Asia , PAINFUL

69
Q

LGV is found where

A

Tropical subtropical locations

= PAINLESS ulcer then, 2-6 weeks buboes painful unilateral inginal LAD (bilateral men, unilateral women)

70
Q

LGV TX

A
  1. Doxycycline

2. Azithromycin or erythromycin (Macrolides) = if pregnant

71
Q

Granuloma Inguinale is found where + TX + biopsy shows

A

India, Papua New Guinea, Caribbean, South Africa, PAINLESS,

  1. Donovan Bodies on bx
  2. Azithromycin (inhibit 50s ribosome)
72
Q

50 S inhibitors

A
  1. Azithromycin
  2. Erythromycin
  3. Clarithromycin
  4. Clindamycin
  5. Lincomycin
73
Q

30 S inhibitors

A
  1. Doxycycline
  2. Tetracycline
  3. Tigercycline
  4. Demeclocyclin
74
Q

Toxic Shock Syndrome SX

+PE + from what

A
  1. RAPID Fever, macular rash on palms of hand abd pain, watery D, hypotension, Fever,
  2. Conjunctiva erythema, sunburn like rash
  3. Staph. Aureus
75
Q

Staph aureus is what type of bacteria

A

Catalase + (Staph) , coagulase + , GRAM + , cluster cocci

= lipase, staphylkinase (clot destroying), Hyaluranidase ( CT destroying ) , Hemolysins Leukocidins, PNCase, Protein A

76
Q

TSST-1 moa

A

Crosslinks T-cells and M (MHC2) = release of cytokines

77
Q

TSS tx

A
  1. Remove tampons
  2. Vasopressin
  3. Empirical AB until culture, + Cephalosporin + Tazolactam, Vancomycin *
    = Pipercillin / Tazobactam (Zosyn, PID also)
    = Cefepime (4 gen, used for Enterobacteriaceae infections)
    = Meropenem ( can cause C diff, preg safe)
    = Imipenem / Cilastatin (not MRSA, only Pseudomonas, others + GIVE with CILASTATIN to prevent renal degradation )
78
Q

Vancomycin used when and moa

A

Glycopeptide AB, made of non ribosome peptides = inhibit cell wall synthesis , needs Lactate
= MRSA

79
Q

Enzyme bacteria make for resistance

A

Beta Lactamase enzyme (PNC resistance bacteria)

80
Q

How to bind B-lactamase enzymes more efficiently to prevent resistance

A

PNC + Tazobactam

81
Q

TORCH infections

A

Toxoplasmosis, Other (Parvovirus B19, syphilis, VZV), Rubella, CMV, HSV/HIV
= all are dna except rubella and hiv and toxo is a parasite

82
Q

Toxoplasmosis SX

+ and does what to baby

A
  1. Asymptomatic usually
  2. LAD, Chorioretinitis (eye pain and blurry), intracranial calcifications
  3. Neuro probs, stillbirth
83
Q

DX toxoplasmosis

A
  1. IgG and IgM serology

2. Spiramycin, Pytimethamine to tx

84
Q

Syphilis in newborn SX EARLY

A

1.mucous membranes involvement + Rhinitis (Snuffles), RASH (palms, soles, genitals), LAD, lymphadenopathy

85
Q

Syphilis in newborn SX LATE 3

A
  1. Gamma formation
  2. CN 8 effects = hearing loss
    3 bone and teeth = saber shins, saddle noise, Hutchinsons teeth, frontal bossing
    = after 2yo
86
Q

DX Syphilis + TX

A
  1. RPR+ VDRL ——> FTA-ABS

2. PNC

87
Q

Varicella Zoster Virus

  1. Sx
  2. Congenital varicella syndrome
  3. Peripartum VZV tx
A
  1. Various stages of healing vesicles rash
  2. Limb hypoplasia, cicatricial skin lesions, eye probs
  3. Acyclovir
88
Q

Parvovirus B19

  1. Sx
  2. Risk of fetus
  3. Virus does what
A
  1. Slapped Cheeks red
  2. Fetal loss, fetal anemia, hydrops fetalis , high fetal death
  3. Viral DNA Attacks RBCs
89
Q

Rubella

  1. SX
  2. Fetal causes
  3. What usually happens in born infant with this
A
  1. Mild fever, face —> truck = head to toe rash, Soft palate petechia (Forchheimer spots)
  2. Congenital Rubella Syndrome = Hearing loss, congenital heart disease PDA, cataracts,
  3. Blueberry muffin baby
90
Q

Rubella DX

A

Serum IgG

91
Q

CMV

  1. How common + fetal cause what
  2. Sx
A
  1. Most common viral congenital infection, Fetal hearing loss, Chorioretinitis (eye)
  2. Asymptomatic usually , mono life sx (fever, HA, pharyngitis)
92
Q

CMV cells seen + tx

A

Owen eye inclusions (with inclusions around)

+ Supportive care

93
Q

HSV

  1. Sx in fetus
  2. Tx
A
  1. Usually during birth (vertical TR)
  2. Skin, eye, mouth probs, CNS probs
  3. Acyclovir
94
Q

Pregnant women screened for Group B strep when

A

35-37 weeks , vaginal + rectal swab

95
Q

Group B strep can cause what to fetus

A

Sepsis, meningitis, Pneumonia (up to 3 month after birth)

96
Q

Strep Agalactiae ( Group B strep)

  1. What type
  2. Group on it
  3. Virulence factor
A
  1. Gram + Cocci, chains
  2. Lancefield group B
  3. Anti-Phagocytic Capsule
97
Q

Group B strep TX

A
  1. PNC G or Amoxicillin , cephalosporin, clindamycin (if allergic to pnc) during preg or during labor
98
Q

Post Partum Endometritis

  1. Sx
  2. Risk of getting this
  3. TX
A
  1. fever, uterine tenderness , tachy, midline lower ABD pain
  2. Group B strep colonization , C-sections delivery
  3. Group A and Group B strep = Gentamicin + Clindamycin **, OR ampicillin/Sulbactam
99
Q

IUD infection that is common

  1. Associated with
  2. Sx
  3. Bx seen
A

Actinomyces = Gram + filamentous bacteria

  1. Long term IUD
  2. Vagina discharge, Pelvic pain
  3. Sulfur granule on bx
100
Q

Mastitis

  1. Sx sore/cracked nipples, fever, myalgia, redness, swollen, and tender breast
  2. Most common infection
  3. TX
A
  1. Sx sore/cracked nipples, fever, myalgia, redness, swollen, and tender breast
  2. Staph. Aureus
  3. Regularly empty breast* + (Cephalexin/Diclocacillin/ amoxicillin/clavulanate = MSSA) (Clindamycin / Trimethoprim/sulfamethoxazole = MRSA)
101
Q

Prevent resistance

A
  1. Tazobactam + PNC (inhibit b-lactamase enzyme)

2. Amoxicillin + Clavulanate ( inhibit penicillinase )

102
Q

Bacteria that resistant to PNC make

  1. BACTRIM MOA
  2. Side effects of bactrim
A

Penicillinase

  1. Block TH4 synthesis = Sulfamethoxazole + Trimethoprim **
  2. Kernicterus in neonate (high bilirubin in CNS)

ENRP Exam 1 (13 decks)

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