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IPAP Senior OB Test 3 > Gynecologic Infections > Flashcards

Gynecologic Infections Flashcards

1
Q

MCC od vaginal discharge

A

Bacterial Vaginosis (BV)

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2
Q

Pt has profuse grey/milky vaginal discharge w/ string fishy odor. you suspect?

A

bacterial vaginosis (BV)

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3
Q

What is included in the Amsel criteria to diagnose bacterial vaginosis (BV)

A

Homogeneous discharge
pH >4.5
+ “whiff” test
Clue cells on wet prep

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4
Q

Tx of Bacterial Vaginosis (BV)

A

Metronidazole- 500mg BID x 7 days
Metronodazole gel-5g intrvag QD x 5 days
Clindamycin cream- 5g intravag Q HS x 7 days
Tinidazole- 2g PO QD x 2days / 1g PO QD x 5 days
Clindamycin- 300mg PO BID x 7 days

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5
Q

Pt has Hx of recurrent BV & NO prior long term Tx

A

give PO Metronidazole or PO Tinidazole or vaginal Clindamycin x 2 weeks

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6
Q

Pt has Hx of recurrent BV w/Hx of prior long term Tx

A

same Tx x 2 wks;

add suppression–> 1x weekly metrogel or 2x weekly PO metro or Tinidazole x 6months

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7
Q

Pt presents w/ vaginal burning/itching, irritation, post-void dysuria, odorless thick white “cottage cheese” discharge

A

Vahinal Candidiasis (C. Albicans MC)

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8
Q

Diagnosis of vaginal candidiasis

A

Vulvovaginal erythema
pH < 4.5
budding yeast, pseudohyphae on KOH

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9
Q

Tx of single/isolated vaginal candidiasis infx

A

w/ “azole” or nystatin intravag 3-7 days;

single dose of PO Fluconazole

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10
Q

Risk factors of vaginal candidiasis

A 
increased estrogen levels
immunosuppression
Environmental
DM
ABX use
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11
Q

Chonic vaginal candidiasis is associated w/?

A

decreased concentration in mannose binding lectin &

increased concentration of interleukin-4

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12
Q

definition of recurrent vulvovaginal candidiasis

A

> /= 4 episodes in 1 yr

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13
Q

recurrent vulvovaginal candidiasis evalutation

A

Revisit Pt Hx
speculum exam
NAAT & Wet Prep/KOH
fungal culture w/sensitivities

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14
Q

Tx for acute recurrent vulvovaginal candidiasis

A 
local intravag therapy 7-14 days
PO fluconazole (200mg) 1 pill q 72hrs x 3 doses --> days 1, 4, 7

Suppression Tx: PO Fluconazole 100-200mg weekly x 6 months

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15
Q

if non-albicans species is found on culture of recurrent vulvovaginal candidiasis Tx w/?

A

PO Fulconazole 150-200mg q 72 hrs x 3-4 dose (50% cure rate

Boric acid capsule intravag 600mg 1x QD for 2 weeks (60% cure rate)

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16
Q

Sx Tx of external irritation recurrent vulvovaginal candidiasis

A

Topical mid-potency steroids help

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17
Q

Pt presents w/ frothy green/yellowish discharge w/ “musty” odor dyspareunia and sometimes dysuria

A

Trichomoniasis

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18
Q

Diagnosis of Trichomoniasis

A 
Frothy discharge
Strawberry cervix
pH > 4.5
Trichomonads on wet prep
NAAT is GOLD STANDARD for Diagnosis
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19
Q

Tx of Trichomoniasis

A

Metronidazole 2g PO x 1 dose; or
500mg BID for 2 weeks (compliant Pts only)
Tinidazole 2g once

Tx BV if also co-infected

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20
Q

What is needed after Tx of Trichomoniasis if prolonged or recurrent infx @ 1month and 6 months

A

Tx of Cure

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21
Q

Most common STD infx

A

HSV

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22
Q

Pt presents w/ tingling / itching / burning /paresthesias w/ painful burning that later developed into grouped vesicles on genital area ?

23
Q

Dx of HSV

A

Culture, PCR, Serum antibodies

24
Q

W/ HSV what presents the greatest risk to fetus / neonate

A

initial infx; no antibodies to pass to fetus

25
What type of HSV when it is located on vulvovaginal area
HSV 2
26
Pt presents condylomata acuminatum on genital area you Dx ______; and _____ if doesn't respond to Tx
Genital Warts (HPV); Biopsy
27
Tx of Genital Warts
Provider applied: Podophyllin, trichloroacetic acid (TCA), Bichloroacetic acid (BCA) Pt applied: Podofilox or imiquimod (not during preg) Surgical: tangential scissor excision, tangential shave excision, curettage, electrosurgery
28
Pt presents w/ isolated PAINLESS chancre hard smooth raised rounded borders found on cervix / vagina / vulva
Primary syphilis
29
Dx primary syphilis w/?
RPR or VDRL | confirm w/ FTA-ABS
30
Tx of primary syphilis
PCN 2.4 million units IM
31
Pt presents w/ maculopapular rash on palms / soles / mucous membranes, w/ fever malaise, lymphadenopathy, chondylomata lata
Secondary Syphilis
32
Tx of Secondary Syphilis
PCN 2.4 million units IM
33
Pt presents w/ fever malaise and HA 8 hours after Tx of primary / secondary Syphilis
Jarisch-Herxheimer Reaction
34
Tx of Late latent, tertiary, and cardiovascular syphilis
PCN 2.4 million units IM weekly x 3 doses
35
After Tx Pt should be _______ for serologic testing and clinical reeval; if Tx failure give _______
reeval @ 6month intervals; | PCN 2.4 million units IM weekly x 3 doses
36
Pt present w/ erythematous papule --> pustule --> w/in 48hrs ulceration red/glandular/soft; edges irreg w/erythematous nonindurated, PAINFUL
Chancroid
37
Tx of Chancroid
Azithromycin 1g PO; | Ceftriaxone 250mg IM
38
Pt present w/ urethritis / cervicitis, on culture noted intracellular bacteria
Chlamydia trachomatis
39
Tx of Chlamydia
``` Azithromycin 1 g PO x 1 Doxy 100mg BID x 7 days Tx all sex partners test for other STI's Abstinence x 7 days on antibiotics No TOC needed rescreen in3-4 months ```
40
Primary Tx of Gonorrhea
Ceftriaxone 25mg IM + 1g Azithromycin PO
41
MC organisms cause PID
Chlamydia gonorrhea BV microflora (anaerobes) Genital Mycoplasms (M. hominis, U. urealyticum, M. genitalium)
42
PID is
upper genital tract inflammation/infx | results most commonly from ascending lower tract infex; important due to sequelae
43
what are the sequelae of PID
infertility, ectopic pregnancy, chonic pelvic pain
44
Risk factor of PID
``` Douching single substance abuse multiple sex partners Low socioeconomic status recent new sex partner young other STI's sex partner w/ urethritis or gonorrhea previous Dx of PID ```
45
Diagnostic criteria of PID
Uterine/adnexal or CERVICAL MOTION TENDERNESS in sexually active / those w/ risks; oral temp >101 F Mucopurulent cervical discharge / friability Elevated ESR / CRP WBC in saline microscopy Lab Dx of Chlamydia / gonorrhea US/MRI/Laproscopic Most sensitive
46
Pt present w/ Lower ABD/pelvic pain / yellow vaginal discharge / heavy menstral flow/ fever chills / anorexia / N/V / Diarrhea / dysmenorrhea / Dyspareunia / UTI Sx that DEVELOPED DURING OR SOON AFTER MENSTRATION
PID
47
Inpatient Tx of PID
Cefoxitin IV or Cefotetan IV plus Doxy IV
48
Outpatient Tx of PIT
Ceftriaxone 250mg IM + Doxy 100mg BID x 2weeks | +/- metronidazole 500mg BID for 2 weeks if concomitant Trich infx or recent instrumentation
49
Pt noted to have tender inflamed adnexal mass, U/S noted 6 cm mass in Left adnexa
Tubo-ovarian Abscess (TOA)
50
Tx'd TOA w/ broad spectrum IV ABX, but there has been no response in 24-48 hours
need surgery
51
Triad of toxic shock syndrome
starts --> fever / malaise / diarrhea diffuse macular rash --> red rash, not painful/itchy orthostatic hypotension progressing to shock
52
Tx of Toxic shock syndrome
ABX while awaiting cultures | systemic support
53
Major criteria for Toxic Shock Syndrome
``` Hypotension Orthostatic syncopre SBP < 90 for adult diffuse macular erythroderma Temp >/=38.8C Late skin desquamation ```

IPAP Senior OB Test 3 (6 decks)

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