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ENRP Exam 1 > Gynecologic Infections Part 1 > Flashcards

Gynecologic Infections Part 1 Flashcards

1
Q

26 yo female with 1 week vaginal discharge:

  • sexuallly active monogamous
  • fishy discharge
  • thin and white discharge
  • no irritation or itching

Cervix is normal with moderate thin white discharge on PE. What is the ddx? How to narrow?

A

Vaginitis, Wet Mount, pH:

  • Bacterial Vaginosis
  • Candida
  • Trichomoniasis

Cervicitis, NAAT/PCR

  • Gonorrhea
  • Chlymadia
  • also includes trichomoniasis
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2
Q

26 yo female with 1 week vaginal discharge:

  • sexuallly active monogamous
  • fishy discharge
  • thin and white discharge
  • no irritation or itching

DDx:

  • Bacterial Vaginosis,Candida, Trichomoniasis, Gonorrhea, Chlamydia

What is indicated if KOH Whiff Test is positive (fishy smell) and pH is >4.5

A

Bacterial vaginosis

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3
Q

Bacterial Vaginosis symptoms, pH, KOH Whiff test results, NaCl wet mount results?

A
  • odor and thin milky white fishy smelling discharge
  • >4.5
  • positive KOH whiff test
  • Clue cells and no/few WBC’s
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4
Q

What is bacterial vaginosis associated with?

A

Increased sexual activity and STI’s

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5
Q

What is the #1 cause of vaginal discharge in childbearing women?

A

Bacterial vaginosis

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6
Q

What is considered normal vaginal flora?

A

Lactobacilli which trive in low pH environments and they create it

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7
Q

What organism is most common cause bacterial vaginosis?

A
  • Gardnerella vaginalis
    • creates biofilm allowing other species to adhere
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8
Q

What should bacterial vaginosis due to Gardnerella vaginalis be treated with?

A
  • Metronidazole
  • Tinidazole
  • Clindamycin

all are available in cream or oral pills

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9
Q

MOA for Metronidazole and Tinidazole?

A
  • Disrupts DNA synthesis
    • causes formation of free radicals
  • Bactericidal
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10
Q

Clindamycin MOA? What type of bacteria does this cover?

A
  • Inihibits 50s ribosomal
  • gram positive bacteria and most anaerobes are covered
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11
Q

Metronidazole and Tinidazole AE’s?

A
  • Disulfiram like reaction with alcohol
    • flushing
    • vomiting
    • headache
  • CNS:
    • seizures, ataxia, dizzy
  • Nausea, anorexia, bloating
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12
Q

45 yo with female 3 days discharge, she is sexually active and recently finished abx for a UTI. She has thick white cottage cheese like discharge with vaginal irritation, itchiness, and inflammation.

  • PE shows external genitalia and vaginal erythema/edema, thick white discharge, and cervix is w/o erythema
  • DDx?
A

Vaginitis, Wet Mount, pH:

  • Bacterial Vaginosis
  • Candida
  • Trichomoniasis

Cervicitis is not indicated

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13
Q

45 yo with female 3 days discharge, she is sexually active and recently finished abx for a UTI. She has thick white cottage cheese like discharge with vaginal irritation, itchiness, and inflammation.

  • PE shows external genitalia and vaginal erythema/edema, thick white discharge, and cervix is w/o erythema
  • KOH wet mount shows psuedohyphae and budding, pH is 4.0 (normal)
    • What is the diagnosis?
A

Vaginal Candidiasis

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14
Q

Vaginal Candidiasis symptoms, pH, KOH whiff test, wet mount

A
  • Itchy discomfort dysuria thick clumpy white “cottage cheese” discharge
  • Inflammation and erythema noted
  • ph usually less than 4.5
  • negative KOH whiff test
  • NaCl wet mount has few to many WBC’s
  • Psuedohyphae ( spores if not candidia)
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15
Q

Risks to developing candidia?

A
  • DM
  • Immunosuppression
  • genetic susceptibility
  • Increased estrogen states
  • Broad spectrum abx like fluoroquinolones,cephalosporins, azithromycin
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16
Q

What causes majority of fungal vulvovaginal infections

A

C. albicans

C. glabrata is most common cause of non albicans infection

17
Q

WHat are the Azoles used for vulvovaginal candidiasis?

A

OTC: all topical

  • Clotrimazole
  • Miconazole
  • Tioconazole

Rx:

  • Terconazole (topical)
  • Butoconazole (topical)
  • Fluconazole (oral)
18
Q

How do Azoles destroy fungi?

A

Inhibiting conversion of lanosterol to ergosterol by CYP450 enzyme

19
Q

Fluconazole use during pregnancy?

A

Do not use, could cause serious and specific birth defects

20
Q

Fluconazole warnings?

A
  • Azoles are assoc. with QT prolongation possibly due to inhibition of CYP3A4
  • Use of fluconazole and erythromycin increaes risk of cardiotoxicity and can cause s_udden cardiac death_
  • Caution in patients with renal issues
21
Q

What CYP do Azoles inhbit?

A

CYP3A4

22
Q

26 yo female vaginal discharge 2 weeks. Sexually active 3 partners past year. Thin frothy green foul smelling discharge with va ginal irritation, dysuria, dyspareunia and bleeding after sex.

  • PE: erythema vulva/vagina, punctate hemorrhage on cervix (strawberry)
    • What is ddx?
A
  • BV, candidia and trichomoniasis requiring a wet mount
  • There are signs of cervicitis so testing for Gonorrhea and chlamydia with PCR
23
Q

26 yo female vaginal discharge 2 weeks. Sexually active 3 partners past year. Thin frothy green foul smelling discharge with va ginal irritation, dysuria, dyspareunia and bleeding after sex.

  • PE: erythema vulva/vagina, punctate hemorrhage on cervix (strawberry)
  • Wet mount shows flagellated protozoa and mobile on microscope
    • what is this?
A
  • Trichomoniasis vaginitis
24
Q

Trichomoniasis vaginitis sx?

A
  • Itchy, frothy grey or yellow green malodorous discharge (70% asx)
  • Cervical petechiae (strawberry cervix)
  • pH >4.5
  • KOH whiff usually positive
  • NaCl wet mount shows motile flagellated protozoa with WBC’s
25
Q

What is the most common non-viral STI?

A

Trichomoniasis

26
Q

T. vaginalis features microscopically?

A
  • Flagellated pear shaped protozoan
  • no cysts only trophozoite and doesn’t survive well outside body
  • Humans are only natural host
27
Q

How do you treat Trichomoniasis?

A
  • Metronidazole or Tinidazole
  • both of these are oral
28
Q

In a pregnant patient with Trichomoniasis, what treatement should be avoided?

A

Tinidazole

29
Q

Trichomoniaisis management after treatement?

A
  • Test that it is cured after 2 weeks to 3 months of completing treatment
    • also make sure any partners have been treated

ENRP Exam 1 (7 decks)

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