Gynecological and Pregnancy Related Infections Part 3 Flashcards

1
Q

focused exam of primary outbreak of gential herpes

primary outbreak is more severe than recurrent ones

A

bilateral scattered small shallow vesciles that are painful and bilateral lymphadenopathy with systemic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

recurrent genital herpes

A

unilateral vesicles that can rupture and ulcerate, usually no systemic symptoms

all herpes vesicles can rupture and ulcerate, this is unilateral that is the difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

in herpes there is often associated ________-

A

lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

recurrent herpes infections are common due to the fact that the virus remains latent in the ?

A

sacral ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

herpes simplex is a double stranded _ virus that has lifelong peristency in the _

A

DNA

nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HSV I involvement

A

orofacial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HSV II involvement

A

genital involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

herpes can be transmitted to the infant via

A

vertical transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

herpes cytology shows?

A

molding, multinucleation, margination

molding- nuclei conform the the shape of other nuclei
multinucleation- multiple nuclei form
margination- glass like quality of the nuclei due to viral particles present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

genital herpes treatment specifically target?

A

DNA synthesis

Acyclovir (only one that can be given IV)
Famciclovir
Valacyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

for treatment of genital herpes it is most effective if started within _ hrs.

A

72

72 hrs from onset of lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MOA of acyclovir

A

it is adminsitered as a prodrug and targets herpes virus specific thymidine kinase and cellular kinases phosphoyrlate in order for it to be incorporated into viral DNA and stops the lengthening of DNA strands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how does viral herpes gain resistance to acylcovir?

A

there is a decreased production of thymidine kinase which prevents acyclovir from reaching its triphosphate active state and cannot be incorpoprated into viral DNA to stop synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

primary symphilis presentation

A

bump that is now a open wound and is painless with mild inguinal lymphadenopathy (later stage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

primary syphilis develops a _ chancre 6 weeks after contact

A

painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

_ weeks after a primary infection of syphilis what secondary syphilis presents and shows what

A

6 weeks

condyloma lata wart like lesion on the palms and soles (macular rash)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

the macular rash in syphilis is on the palms and soles what other processes involve the palms and soles

A

rocky mountain spotted fever and toxic shock syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

secondary syphillis usually resolves in 2 months and will remain latent until becoming reactivated and forming tertiarry syphillis when?

A

6-40 years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

tertiary syphillis is characterized by involvement throughout the body and widespread _ formation

A

gumma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are gummas?

A

lesions that involve skin, bones, soft tissue and other organs they show spirochete organisms with a area of central necrosis, paslama cells and histiocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tertirary syphillis can also cause _ with involvement of the vasa vasorum (small vessel that feeds the aorta)

A

thoracic aorta aneurysm/dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

if tertiary syphillis involves the porerior columns of dorsal roots of the spinal cord there is loss of?

this is known as tabes doraslis

A

loss of position and vibration sense below the level of the lesion

patient will often fall with their eyes closed and fee together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

if tertiary syphilis involves the midprain what happens

A

the pupils do not react to light but constrict in focusing with near object(argyll robertson pupils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

sphyillis is caused by?

microbiology

A

treponema pallidum which is a corckscrew spirocete with spinning motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
a key feature in both primary and secondary syphillis is the presence of?
plasma and lymphocytic infiltrarte termed lymphoplasmacytic infiltrate on histology
26
how do gummas in tertirary symphillis present hsitologically ?
they present with large areas of necrosis with histiocytes and plasma cells
27
what stain shows the spirochetal symphilis bacteria
silver stain
28
what are the nontrepnemal screening tests
VDRL, RPR, TRUST ## Footnote nonspecific tests that checks the antibodies (screening test)
29
in syphilis _ is typically utilized to make the diagnosis
serology
30
after a nonspecific test more specific treponemal diagonostic tests check for antibodies against specific antigens: what are these tests?
FTA-ABS
31
if you have a direct tissue sample of syphillis you can use what to test it? ## Footnote 4 of them
PCR (most used- definitve and checks for DNA of syphillis) Darkfield microscopy fluroescent antibody testing silver stain
32
treatment for syphillis (primary/early/secondary/latent)
benzathine penicilin or doxycyline if allergic to penicillin ## Footnote want to target treponema pallidum
33
neurpsyphilis/ocular syphilis (tertiary) is treated with?
aqueous crystalline penicillin G procain penicillin G and probenaecid
34
what is benzathine penicillin
2 penicillin G molecules that react with diphenyethylene diamine that is given IM and contains a beta lactam ring ## Footnote safe during pregnancy
35
what does benzzathine penicillin cover ## Footnote bacteria coverage
gram positive bacterio like beat hemolytic strep gram negative bacteria like trepnema pallidum ( in syphillis)
36
side effects of bezathine penicillin/ beta lactam antibiotics
allergic reactions and analphylactic shock ## Footnote also penicillins and cephalosporins
37
benzathine penicillin can cause a rare reaction when used to treat sphyillis which is termed?
Jarisch-herxheimer
38
a chancroid is usually seen where? | location
in resource poor areas (africa, subsaharan, latin america)
39
chancroid present with
multiple painful genital ulcers and inguinal lymphadenopathy
40
chancroid is caused by?
gram negative bacillus haemophilus ducreyi
41
is testing available for chancroid?
no, but rule out HSV and syphillis
42
how do we treat chancroid
azithromycin, certriacoine, ciprofloxacin, erythromycin
43
lymphogranuloma venerum (LGV) is found where | location
tropical/subtropical locations
44
LGV presentation
one painless geninital ulcer that heals but then develops buboes which are painful unilateral inguinal lymphadenopathy ## Footnote more common in men than women due to lymphatic drainage differences
45
lymphogranuloma venerum is caused by
chlamydia trachomatic L1, L2, L3 serovars ## Footnote a gram negative intracellular bacteria that relies on host ATP
46
treatment of LVG normal vs pregant
normal - doxycline pregnant- macrolides (azithromycin)
47
granuloma inguinale is found? | location
in india, papua new guinae, caribbean
48
granuloma inguinale presentation
painless nodule that slowly enlarges that are beefy red can ulcerate and do NOT HAVE LYMPHADENOPETHY
49
granuloma inguinale is caused by?
gram negative rod klebsiella granulomatosis
50
biopsy of granuloma inguinale shows
donovan bodes which are collections of bacilli in cytoplasma of macrophages, monocytes, or histiocytes
51
treatment of granuloma inguinale
azithromycin
52
azithromycin is?
a macrolide, 50s subuint inhibitor that inhibits protein synthesis
53
what are the macrolides?
erythromycin, azithromycin, clarithromycin
54
toxic shock syndrome is characterized by the rapid onset of?
fever, erythematous rash on palms and soles, desquamation of skin 2 weeks after rash apperance, hypotension + systemic involvement indicationg shock
55
TSS is caused by
staph aureus | can ocurr with MSSA and MRSA ## Footnote usually in mentrual cases but doesnt have to be (high absorbent tampons)
56
staph aureus is a ? | microbiology
gram positive, catalase positive, coagulase positive coccous that is found in clusters
57
what is catalase
a enxyme that breaks down hydrogen peroxide
58
what is coagulase
an enzyme that acitvates the formarion of a fibrin clot to help protect the baceria
59
what are the virulence factors of staph aureus?
hyalurinidase (destroys CT) staphylokinase (destroys clot) lipase (destroys fat)
60
staph aureus produces TSS by releasing what
toxic shock syndrome toxin 1 (TSST-1)
61
what is the mechanism of action of TSST-1?
it acts as a super antigen to crosslink T cells and macrophages this binding releases cytokines that give systemic features like hypotension and fever (shock)
62
how do we treat TSS
remove the foregin body or infection by surgical debriedment, care for the shock symptoms, and start empiric antibiotics
63
what is the glycopeptide that is used to treat TSS
vancomycin
64
vancomycin is used in TSS if the infection is _
suspected to have MRSA (methicillin resistant )
65
what is the MOA of vancomycin?
it inhibits cell wall synthesis of bacateria by creating unstable cross links
66
how has bacteria become vancomycin resistant ?
the resistant strains change from D-ala:D-Ala to D-ala:D-Lac/Ser
67
what is a B-lactamase enxyme
this is an enxyme produced by some bacteria than give them resistance to Antibiotics like penacinllinase which helps it to degrade betalactam rings
68
bacteria that produce extended spectrum b-lactamases are _ strains
multi drug resistant strains
69
how do beta lactamase inhibitors work
they work by extending B-lactam spectrum of antibiotic activity to prevent resistant from betalactamases.
70
what combination drug of betalactam is used to treat TSS
Piperacillin and Tazobactam (zosyn) ## Footnote given IV, covers both gram positive and gram negative can be used to treat PID
71
what cephalosporin can be used to treat TSS
Cefepime ## Footnote 4th generation, covers gram negative and gram positive, cell wall synthesis inhibitors
72
cefepime when treating TSS is a fron tline agent when infection is with _
enterobacteriacea
73
what carbapenems are used to treat TSS
meropenem and imipenem/clistatin ## Footnote beta lactam antibiocs that are cell wall synthesis inhibitors
74
meropenem has what side effects and resistance arise because?
side effects: clostridium difficile and allergic reactions resistance: mutations in penicillin binding proteins
75
is imepenem/cilastatin active against MRSA?
no
76
imipenem is rapidly degraded by?
renal enzyme dehydropeptidase (DHP1)
77
imipenem is coadmisnistered with?
cilastatin which is a DHP1 inhibitor and it prevents inactivation of imipenem