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ENRP II > Gynecological and Pregnancy Related Infections Part 1 > Flashcards

Gynecological and Pregnancy Related Infections Part 1 Flashcards

1
Q

what is the differential diagnosis of vaginal discharge

pathologies that lead to vaginal discharge

A

Bacterial Vaginosis, Candida, Trichomoniasis, Gonorrhea, and Chlamydia

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2
Q

to help narrow the differential diagnosis of vaginal discharge we would utilize?

additional tests used

A

Wet mount, pH, PCR/NAAT and pregnancy teset

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3
Q

PCR is utilize to identify gonorrhea, trichmonasis and chlamydia, what kind of PCR for all 3 is used?

A

endocervical swab, vaginal swab or urine for gonorrhea and chlamydia

vaginal or first voided urine for trichomoniasis

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4
Q

dont forget to check a ____ test when evaluating gynecological complaints because our treatment might be altered

A

pregnancy

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5
Q

what is a clue cell

A

vaginal epithelial cells with bacteria obscuring its borders

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6
Q

what is a postassium hydroxide whiff test

A

when we swab the vaginal place the discharge on a slide and drop postassium hydroxide onto the discharge

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7
Q

what are the three common causes of vaginitis

A

bacterial vaginosis, candidiasis, trichmonasis

bacterial, fungal, parasitic

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8
Q

what are the signs of bacterial vaginosis

discharge, bacterial pH, whiff test, NaCL wet mount

A

homogenous think off white foul smelling discharge
pH >4.5
positive whiff test
clue cells with few RBCs

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9
Q

what is the criteria for diagonsis bacterial vaginosis

A

amsel criteria with 3/4 present

  1. discharge
  2. vaginal pH >4.5
  3. posititve whiff test
  4. clue cells on saline wet mount
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10
Q

what is the pathology of bacterial vaginosis

A

overgrowth of anerobic bateria which replaces normal bacterial flora

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11
Q

bacterial vaginosis is not a sexually transmitted disease BUT is associated with ?

2 things

A

increased sexual activity and concomittant secually transmitted diseases

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12
Q

what concomitant secually transmitted infections are associated with BV

A

HIV, gonorrhea, chlamydia, herpes, HPV

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13
Q

____ has a slight anti-estrogenic effect wich can predispose you to changes in the vaginal flora

A

smoking

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14
Q

normal vaginal flora consits of ______

bacteria

A

lactobacilli

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15
Q

lactobacilli are ____ anaerobic gram _____ bacilli that predominate in the vagina shortly after menses

A

aerotolerant

gram negative

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16
Q

lactobacilli create ____ and ____ which lowers the pH

A

hydrogen peroxide and lactic acid

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17
Q

pH of the vagina rises when there is contraceptive devices implanted, secual intercourse etc. and there is a shift in bacteria to ?

A

anerobic coccobacilli (clue cells, cover squamous cells)

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18
Q

what are the typical microorganisms that cause bacterial vaginosis?

A

anerobic and facultative anerobic coccobaccili like** gardnerlla vaginalis**, prevotella species, and atopbium vaginae

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19
Q

gardnerella vaginalis plays a pivotal role in creating a ____ that allows other bacteria to create a bacterial mass

A

biofilm

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20
Q

what causes the fishy smell in BV

A

the anerobes and facultative anerobes merge together to create volatile, malodorous amines

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21
Q

what are the choice of drugs to treat BV?

A

metronidazole, tinidazole, clindamycin

all in PO or vaginal cream formations

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22
Q

what is the MOA of nitroidazoles (metronidazole and tinidazole)

A

causes DNA damage by first being acitvated by nitroreductase and releasing free radicals that causes loss of DNA helical structure, strand breakage, and inhibits protein synthesis (DNA replication is lost)

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23
Q

mtronidazole and tinidazole causes cell death in susceptible organisms like

A

trichomonas

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24
Q

what are the side effects of nitroimidazoles

A

Disulfuram-like reaction with alcohol (flushing, vomiting, headache), CNS distubances, nausea/bloating/cramping

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25
Q

metabolism of nitroimidazoles is through?

A

glucuronidation

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26
Q

nitroimidazoles are eliminated how?

A

through the urine unchanged

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27
Q

does nitroimadizoles penetrate the CSF

A

yes, and abcessess too

28
Q

clindamycin is a ________ that is used when there is a patient allergic to ____

A

lincosamide

allergic to penicillin

29
Q

clindamycin covers?

what type of bacteria

A

gram positives and anaerobes

30
Q

clindamycin is used to treat ____ and to decrease the risk of premature births in women with BV

A

toxic shock syndrome

**pelvic inflammatory disease too

31
Q

MOA of clindamycin

A

binds to the 50s bacterial subunit to inhibit transpeptidation

transpeptidation is peptide chain elongation

32
Q

adverse affect of clindamycin

A

C.diff which can lead to overgrowth and release of toxins

33
Q

does clindamycin penetrate the csf?

A

no but does penetrate abcesses

34
Q

what are the presentations of candidiasis

pH, discharge, NaCL wet mount, whiff test, KOH wet mount

A

ph<4.5
thick clumpy cottage cheese discharge
negative whiff test
KOH wet mount has psuedohyphae
no cervitis
erythema on vulva

35
Q

to better assess candidia on wet mount we should use?

A

KOH (postassium hydroxide rather than NACL)

36
Q

is candadiasis a sexually transmitted disease

A

no

37
Q

Risk factor for vulvovaginal candidiasis ?

A

diabetes, high estrogen states, immunosuppresion, antibiotics (fluroquinolones)

38
Q

in diabetes candidia can thrive in ____ glucose environments

A

higher

39
Q

HIV and immunosuppresion both decrease ____ response to infection by candida

A

immune

40
Q

pregnancy and post-menopausal estrogen therapy can increase the risk of candida due to ____ states

A

increased estrogen

41
Q

antibiotics can cause candida because they ?

A

inhibit normal flora and favor the growth of candidia species

42
Q

symptomatic infection with candida is only seen with?

A

invasion of the squamous cells (massive overgrowth)

43
Q

________ is the most common cause of vulvovaginal infections

A

candida albicans (also could be candida glabrata due to fungal drugs being used to being target albicans)

44
Q

over the counter azoles that treats candiasis

A

clotrimazole, miconazole, ticonazole

all vaginal suppositories

45
Q

prescription vaginal suppositories for candidiasis

A

terconazole and butoconazole

46
Q

oral prescription drug to treat candidiasis?

A

flucanazole

47
Q

MOA of azoles (anti-fungal)

A

inhibit conversion of lanosterol to ergosterol by CYP450 system

cant form fungal cell wall, cell membrane disruption

bind to active site of 14a demethylase CYP450 enzyme

48
Q

flucanazole side effects

azoles

A

potential for fetal harm/birth defects, prolong QT interval (torsades)

49
Q

QT prolongation caused by other medicines may be amplified via the flucanazole-mediated inhibition of ?

A

cytochrome P450/(CYP3A4)

50
Q

flucanazole given with erythromycin can cause?

A

cardiotoxicity, sudden heart death

51
Q

flucanazole should be adminsitered with caution to patients with ____ dysfunction

A

renal dysnfunction

52
Q

azole antifungals are ____ and ____ of the CYP3A4 family

A

inhbitors and substrates

increases the serum concentrations of numerous drugs and can lead to potentially serious and lethal drug-drug interactions

53
Q

what is the primary route of excretion for flucanzole

azole (antifungal)

A

renal excretion

patients with liver or renal failure are at increased risk for drug drug interactions due to not being able to metabolize the drug

54
Q

dyspurina

A

pain with sex

55
Q

vaginitis tests

A

wet mount, pH

56
Q

cervitis tests

A

PCR/NAAT

57
Q

what are the presentations of trichmoniasis

discharge, cervix findings, pH, whiff test, NACL wet mount

A

green/yellow malodorous discharge
cervical petichiae (strawberry cervix)
pH>4.5
positive whiff test
NaCl wet mount with motle flagellated protazoa

58
Q

trichomoniasis is the most common ________ sexually tranmitted disease

A

nonviral

59
Q

trichomonasis is associated with other sexually transmitted diseases like ?

A

HIV and HPV

60
Q

what increases the risk for trichomoniasis

A

multiple sexual partners

61
Q

trichmonas vaginalis is a flagellated pear shaped ________

A

protazoan

no cyst formation so it does not survive outside the body

62
Q

____ are the only natural hosts of trichomonas vaginalis

A

humans

63
Q

T. vaginalis reproduces through

A

binary fission

asexual replication where the organism splits in half*** infect squamous epithelium

64
Q

treatment of trichmoniasis

A

treat any sexual partners to present reinfection

metroidazole and tinidazole

use mitronidazole in pregnancy

65
Q

you should retest patients with trichomoniasis when ?

A

2 weeks to 3 months after completing treatment

ENRP II (25 decks)

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