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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 ?

A

HSV

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
Q

What type of HSV when it is located on vulvovaginal area

A

HSV 2

26
Q

Pt presents condylomata acuminatum on genital area you Dx ______; and _____ if doesn’t respond to Tx

A

Genital Warts (HPV); Biopsy

27
Q

Tx of Genital Warts

A

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
Q

Pt presents w/ isolated PAINLESS chancre hard smooth raised rounded borders found on cervix / vagina / vulva

A

Primary syphilis

29
Q

Dx primary syphilis w/?

A

RPR or VDRL

confirm w/ FTA-ABS

30
Q

Tx of primary syphilis

A

PCN 2.4 million units IM

31
Q

Pt presents w/ maculopapular rash on palms / soles / mucous membranes, w/ fever malaise, lymphadenopathy, chondylomata lata

A

Secondary Syphilis

32
Q

Tx of Secondary Syphilis

A

PCN 2.4 million units IM

33
Q

Pt presents w/ fever malaise and HA 8 hours after Tx of primary / secondary Syphilis

A

Jarisch-Herxheimer Reaction

34
Q

Tx of Late latent, tertiary, and cardiovascular syphilis

A

PCN 2.4 million units IM weekly x 3 doses

35
Q

After Tx Pt should be _______ for serologic testing and clinical reeval; if Tx failure give _______

A

reeval @ 6month intervals;

PCN 2.4 million units IM weekly x 3 doses

36
Q

Pt present w/ erythematous papule –> pustule –> w/in 48hrs ulceration red/glandular/soft;
edges irreg w/erythematous nonindurated, PAINFUL

A

Chancroid

37
Q

Tx of Chancroid

A

Azithromycin 1g PO;

Ceftriaxone 250mg IM

38
Q

Pt present w/ urethritis / cervicitis, on culture noted intracellular bacteria

A

Chlamydia trachomatis

39
Q

Tx of Chlamydia

A 
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
Q

Primary Tx of Gonorrhea

A

Ceftriaxone 25mg IM + 1g Azithromycin PO

41
Q

MC organisms cause PID

A

Chlamydia
gonorrhea
BV microflora (anaerobes)
Genital Mycoplasms (M. hominis, U. urealyticum, M. genitalium)

42
Q

PID is

A

upper genital tract inflammation/infx

results most commonly from ascending lower tract infex; important due to sequelae

43
Q

what are the sequelae of PID

A

infertility, ectopic pregnancy, chonic pelvic pain

44
Q

Risk factor of PID

A 
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
Q

Diagnostic criteria of PID

A

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
Q

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

A

PID

47
Q

Inpatient Tx of PID

A

Cefoxitin IV or Cefotetan IV plus Doxy IV

48
Q

Outpatient Tx of PIT

A

Ceftriaxone 250mg IM + Doxy 100mg BID x 2weeks

+/- metronidazole 500mg BID for 2 weeks if concomitant Trich infx or recent instrumentation

49
Q

Pt noted to have tender inflamed adnexal mass, U/S noted 6 cm mass in Left adnexa

A

Tubo-ovarian Abscess (TOA)

50
Q

Tx’d TOA w/ broad spectrum IV ABX, but there has been no response in 24-48 hours

A

need surgery

51
Q

Triad of toxic shock syndrome

A

starts –> fever / malaise / diarrhea
diffuse macular rash –> red rash, not painful/itchy
orthostatic hypotension progressing to shock

52
Q

Tx of Toxic shock syndrome

A

ABX while awaiting cultures

systemic support

53
Q

Major criteria for Toxic Shock Syndrome

A 
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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