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ENRP Exam 1 > Gynecologic Infection Part 3 > Flashcards

Gynecologic Infection Part 3 Flashcards

1
Q

Genital Herpes:

  • agent
  • lesion
  • painful/painless
  • lymphadenopathy
  • constitutional sx
A
  • Caused by HSV 2
  • Early on lesion is vesicles and erythematous, later on lesions are ulcerated shallow and have raised edges
  • Multiple Painful lesions
  • Inguinal lymphadenopathy present
  • constitutional sx present
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2
Q

Chancroid:

  • agent
  • lesion
  • painful/painless
  • lymphadenopathy
  • constitutional sx
A
  • H. ducreyi
  • Purulent base, non indurated ulcer with ragged edges
  • Multiple Painful lesions
  • Inguinal lymphadenopathy present and buboes
  • no constitutional sx
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3
Q

Syphillis:

  • agent
  • lesion
  • painful/painless
  • lymphadenopathy
  • constitutional sx
A
  • T. pallidum
  • Ulcer/chancre that isindurated with demarcated edges
  • Painless singular lesion
  • Lymphadenopathy present in late primary syphilis
  • constitutional sx in secondary syphilis
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4
Q

LGV:

  • agent
  • lesion
  • painful/painless
  • lymphadenopathy
  • const. sx
A
  • C. trachomatis L1, L2, L3
  • Early on papule later small shallow ulcer
  • painless singular lesion
  • painful lymphadenopathy in secondary see buboes
  • secondary see constitutional sx
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5
Q

Where does herpes remain latent?

A

Sacral ganglia

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6
Q

How is Herpes simplex transmitted and what are the usual sites of involvement?

A
  • transmitted via saliva, vaginal secretions and direct contact with an ulcerative lesion
  • HSV 1: orofacial
  • HSV 2: genital
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7
Q

Herpes cytology?

A

Infects squamous cells, has “Three M’s”:

nuclear Molding, multinucleated and margination

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8
Q

How do you treat genital herpes? When are they most effective

A
  • Acyclovir or Famciclovir or Valacyclovir
  • Most effective if started within 72 hours
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9
Q

Acyclovir MOA?

A

Targets thymidine kinase specific to herpes virus, leads to inhibition of replication

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10
Q

How does resistance to Acyclovir occur?

A
  • Decreased or absent production of viral thymidine kinase
  • This prevents acyclovir from reaching activated triphosphate state
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11
Q

30 yo woman 2 weeks of a singular genital lesion. It started witha bump and is now an open painless wound. 1-2 cm ulcer on inferior vulva with a raised and indurated border, not tender to palpation. Mild inguinal lymphadenopathy is present. She has had one new partner over the last 3 months.

What is this?

A
  • Syphilis, the lesion is a chancre
  • it is painless and develops 3-6 weeks after contact
  • after 6 weeks of primary infection secondary syphillis can occur
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12
Q

Secondayry syphils?

A
  • Macular rash
  • formation of wart like lesion called condyloma lata
  • rash involves palms and soles
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13
Q

What are the sixes of syphilis?

A
  • Chancre develops after 6 weeks of inital contact
  • 6 weeks after primary infection secondary syphilis develops
  • 6 months after secondary tertiary syphilis develops
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14
Q

Tertiary syphilis?

A
  • Gummatous lesions in the skin and bones
  • CV syphilis: thoracic aortic aneurysm
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15
Q

What happens if syphilis involves the posterior columns and dorsal root ganglia?

A
  • loss of coordination
  • loss of pain/temp sensation
  • diminished proprioceptive and vibratory sensation
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16
Q

What happens if syphilis involves the midbrain>

A

Argyll Robertson pupils, pupils do NOT constrict when exposed to light, but DO constrict when an object is brought close

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17
Q

What causes syphilis, what does histo show, what is on silver stain?

A
  • T. pallidum
    • spinning motility to invade tissues
  • Histo shows lymphoplasmacytic infiltrate
  • Corckscrew organism on silver stain
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18
Q

How is syphilis diagnosed?

A
  • Non treponemal screening tests such as VDRL & RPR
  • after positive screen treponemal diagnostic tests are done, FTA-ABS
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19
Q

Syphilis treatment if primary secondary or early latent phase?

A
  • Benzathine Penicillin
    • if allergic use doxycycline
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20
Q

Neurosyphilis treatment? Occular syphilis tx?

A

Aqueous crystalline penicillin G

Procaine penicillin G and Probenecid

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21
Q

Is benzathine penicillin safe for pregnancy?

A

Generally safe

22
Q

What is Benzathine penicillin active against?

A
  • Gram positive beta hemolytic streptococci
  • Gram negative T. pallidum and T. carateum
23
Q

Benzathine penicillin MOA?

A
  • Inhibition of cell wall synthesis
  • AE’s:
    • allergic reactions, minor like rashes itching or flushing
    • small fraction have serious reaction
24
Q

what locations is chancroid common to?

A
  • resource poor areas:
    • Sub Saharan Africa
    • Latin America
    • Southeast Asia
25
Q

Chancroid treatment?

A
  • Azithromycin (macrolide)
  • Ceftriaxone (3rd gen)
  • Ciprofloxacin (flouroquinolone)
  • Eruthromycin (macrolide)
26
Q

Where is Lymphogranuloma venerum commonly found?

A
  • Mostly in tropical/subtropical locations
    • east and west africa, india, southeast asia, caribbean
27
Q

LGM treatment?

A
  • Doxycyline (tetracycline) (if not pregnant)
  • Azithromycin or Erythromycin
28
Q

Granuloma Inguinale:

  • agent
  • lesion
  • painful/painless
  • lymphadenopathy
  • constitutional sx
A
  • K. granulomatis
  • beefy red ulcer
  • painless
  • psuedobuboes
  • no constitutional sx
29
Q

Where is Granuloma Inguinale commonly found?

A
  • It is not common
  • can be found in india, papa new guinea, caribbean, and southern africa
30
Q

What genital lesion shows Donovan bodies?

A

Granuloma inguinale

31
Q

Treatment for Granuloma inguinale?

A

Azithromycin

32
Q

MOA of azithromycin?

A

50s ribiosome inhibition

33
Q

22 yo with 1-2 days diffuse red rash on palms and soles of feet. Assoc. fever abdomen pain and watery diarrhea. On period for last 5 days using tampons.

  • BP: 85/50 T:103.5
  • General: appears ill slightly disoriented
  • Skin: rash involves soles and palms, diffusly erythematous macular rahs looks like sunburn
  • Conjunctival erythema
  • Pelvic exam shows tampon

What is this?

A
  • Staphylococcal TSS
34
Q

Toxic Shock Syndrome presentation?

A
  • rapid fever onset
  • diffuse macular rash erythematous and involves hands/feet
  • desquamation of rash 1-2 wks later
  • hypotension
  • signs of multiorgan involvement
35
Q

S. aureus microbiology?

A
  • Gram positive
  • Catalase positive
  • Coagulase positive
  • cocci in clusters “grape like”
36
Q

What are the tissue destroying proteins that S. aureus has?

A
  • Hyaluronidase (CT destroyer)
  • Staphylokinase (clot destroyer)
  • Lipase
37
Q

MOA of TSS?

A
  • TSST-1 acts as super antigen and crosslinks T cells and macrophages (via MHC II) inducing release of cytokines
    *
38
Q

Treatment of TSS?

A
  • removal of tampon or other source of infection
  • supportive care for shock
  • empiric abx until culture
39
Q

In a patient with TSS with suspected Methicillin resistant S. aureus what should be sued to treat it?

A

Vancomycin

40
Q

What type of drug is vancomycin?

A
  • Glycopeptide, a drug of last resort that inhibits cell wall biosynthesis
41
Q

How does resistance to vancomycin occur?

A

Resistant strains produce D-ala: D-lac or D-ala: D-ser instead of D-ala:D-ala at the C terminal, and vancomycin doesn’t have high affinity for those

42
Q

What drug extend Beta lactam spectrum of abx activity to prevent antimicrobial resistance?

A
  • Tazobactam
43
Q

Pipercillin/Tazobactam?

A

Used to treat toxic shock syndrome and PID and others… covers gram + and gram - including psuedomonas

given IV

44
Q

Cefepime?

A
  • 4th gen cephalosporin
  • active against psuedomonas, s. aureus, MDR strep pneumoniae
45
Q

TSS treatment?

A
  • Cefepime
  • Pipericillin/Tazobactam
  • Meropenem
  • Imipenem/Cilastatin
46
Q

When is cefepime a first line agent?

A

WHen infection is with enterobacteriaceae

47
Q

What are the serious side effects of meropenem?

A
  • C.diff infection
  • seizure
  • allergic rxn
    • anaphylaxis
48
Q

Meropenem use in pregnancy and how does resistance arise?

A
  • safe
  • resistance due to mutations in penicillin binding proteins
49
Q

What bugs are Imipenem/Cilastatin active against?

A
  • Psuedomonas and Enterococci
  • NOT MRSA
50
Q

How is Imipenem metabolized?

A

Renal enzyme dehydropeptidaase 1 (DHP1), so it is co administered with cilastatin (DHP1 inhibitor) to prevent this

ENRP Exam 1 (7 decks)

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