Gynecological and Pregnancy Related Infections Part 2

Question 1

what are the common presentations of cervicitis

Answer 1

mucopurulent discharge, bleeding between menses, dysuria, urethritis

Question 2

what are the most common pathogens that cause cervicitis?

Answer 2

chalmydia, gonhorrea, trichomonas, mycoplasma genitalium

Question 3

neisseria gonorrhea is a (blank) gram ____ diplococcous that grows on?

Answer 3

intracellular

gram negative

grows on thayer-martin chocolate agar

Question 4

what is a chocolate agar?

Answer 4

an antibiotic infused heated blood agar that releases hemin and NAD

Question 5

what are the virulence factors for neisseria gonorrhea and what do they do

Answer 5

pili which allows it to adhere to cells throughout the gynecolgic tract

igA1 protease and OPa proteins which allow it to avoid immune protection

Question 6

chlamydia trachomatis is a tiny ________ intracellular bacteria that does not appear on ?

Answer 6

obligate (gram negative)

does not appear on gram stain

Question 7

chlamydia has an extracellular infectious particle termed?

it has an active parasitic form termed?

Answer 7

elementary body

reticulate body

Question 8

what does the reticulate body of chlamydia do?

Answer 8

steals ADP and ATP energy from host cell

Question 9

mycoplasma genitalium does not have what?

it can cause cervicitis and what else?

Answer 9

cell wall (very small)

non-gonoccoal urethritis

Question 10

how do we treat cervicitis?

Answer 10

empirically at first to cover gonorrhea and chlamydia

intramuscular cftriazone and oral azirthomycin

in case of azithromycin allery use doxycylin

Question 11

ceftriaxone is?

Answer 11

a third generation cephalsporin that includes a beta lactams and inhibits cell wall synthesis

1st gen- gram +
2nd gen- gram - and more resistant to beta lactamases

Question 12

ceftriazone is adminsitered how? it penetrates what?

Answer 12

IM and penetrates the CSF

Question 13

side effects of ceftriaxone

Answer 13

acalulous cholestasis and bilirubin displacment

Question 14

azithromycin is?

Answer 14

macrolide that inhibits 50s subunit of ribosomes

Question 15

azithromycin can treat what?

Answer 15

bacteria lacking cell walls (chlamydia, mycoplasma)

cause cervitis

Question 16

how do you take azithromycin?

Answer 16

PO/IV

Question 17

side effects of azithromycin

Answer 17

GI upset, abdominal pain

Question 18

doxycycline is?

Answer 18

30s ribosome inhibitor to inibit protein synthesis (category D) - tetracycline

avoid in pregnancy

Question 19

adverse affects of doxycycline

Answer 19

chelator dont give with milk, antacid, ca+ or fe+

Question 20

Pelvic inflammtory disease key features

Answer 20

fever, lower abdominal pain, pelvic pain, cervical motion tenderness (chandelier sign)

Question 21

workup of PID

Answer 21

same for cervitis and ultrasound to evaluate uterus, ovaries, and fallopian tubes

wet mount, pH, PCR/NAAT

Question 22

what are the most common causes of PID

Answer 22

neisseria gonorrhea and chlamydia

mycoplasma genitalium , BV

Question 23

Pelvic inflammatory disease begins in the _ and spreads up through the _

Answer 23

vagina/vulva

spreads up through the genital tract

Question 24

acute infection in the cervix/ uterus is termed

infection of the fallopian tubes with abundant neutrophils is termed

acute infection of the tubes and the ovaries is termed that also incoporated pus in the fallopian tubes is termed?

Answer 24

cervicitis

acute suppurative salpingitis

pyrosalpinx and tubo-ovarian abcess

Question 25

a tubo-ovarian abcess is what? and presents with what?

presents with 3 things

Answer 25

it is a late stage complication of pelvic inflammatory disease that results in a cystic mass with multiple lobulares (filled with inflammation)

there is an adnexal mass, fever, leukocytosis, and abdominal pelvic pain

Question 26

if pelvic inflammtory disease spreads to the peritoneal cavity beyond the ovary this can cause

Answer 26

inflammtinon around the liver capsule and diapragm cauing fitz-hugh curtis syndrome

Question 27

fitz-hugh curtis syndrome presents with the sudden onset of?

Answer 27

abdominal pain, fever, nausea, and vomiting

Question 28

other complications of PID

Answer 28

disseminated infection through bactermia

septic arthritis

infertility and ectopic pregnancy through scarring of the fallopian tube

neonatal conjunctivitis/blindness through vertical transmission from gonohrrea and chlamydia

Question 29

neonatal blindness caused by gonorrhea and chlamydia presents like?

Answer 29

swelling of the eye, erythema, discharge

Question 30

when would we treat PID inpatient

Answer 30

if there is severe illness like high fever, severe pain, nausea, vomiting, abcess, surgery is needed or pregnancy

Question 31

outpatient medication for PID

if complicated?

Answer 31

ceftriazone and doxycylcine

if complicated consider adding metronidazole

Question 32

inpatient medication for PID

if pregnant?

Answer 32

doxycycline + cefoxitin or cefotetan

if pregnant clindamycin and gentamicin

Question 33

cefoxitin and cefotetan are _____

Answer 33

beta lactam cell wall synthesis inhibitors

2nd generation cephalosporins

Question 34

cephalosporins have 2 main advantages over penicilins which are?

Answer 34

more resistant to beta lactamases but more sensittive to cephalosporinases

more chemical versatility because of an new R group

Question 35

second generation cephalosporins like cefoxitin and cefotetan cover?

Answer 35

nesiseria gonorrhea

Question 36

side effects of cefoxitin and cefotetan

Answer 36

gi disturbances, neurotoxicity, nephrotoxicity, hepatic enzyme abnormalities, hematologic problems

Question 37

gentamicin is a _

Answer 37

amino-glycoside, category D drug that inhibits protein synthesis that inhibits the 30s subunit

category D- positive evidenece of human fetal risk (benefit may outweigh the risk)

Question 38

anerobic bacteria are resistant to getamicin because transport of gentamicin into bacteria is?

Answer 38

oxygen dependent

Question 39

side effects of gentamicin

as well as other aminoglycosides

Answer 39

ototoxicity (irreversible) (BB warning)
nephrotoxicity (BB warning)
complete neuromuscular blockade

complications are higher in people with impaired renal function