ID 4

Question 1

Urethritis – Tx?

Answer 1

Cefexime or Ceftriaxone (gonorrhea)+Azithromycin or Doxycycline (chlamydia)

Question 2

Urethritis – best initial test?

Answer 2

Urethral swab for Gram stain

Question 3

Causes of Urethritis other than Gonorrhea/Chlamydia?

Answer 3

Mycoplasma genitalium & Ureaplasma

Question 4

Cervicitis – presentation?

Answer 4

Cervical discharge & inflamed “strawberry” cervix on PE

Question 5

Cervicitis – Tx?

Answer 5

• Testing & Tx are identical to UrethritisTx =Cefexime or Ceftriaxone (gonorrhea)+Azithromycin or Doxycycline (chlamydia)

Question 6

Pelvic Inflammatory Disease (PID) – presentation?

Answer 6

• Lower abdominal tenderness- Lower abdominal pain- Fever- Cervical motion tenderness- Leukocytosis

Question 7

PID – best 1st step?

Answer 7

Exclude pregnancy!

Question 8

Dx?Painless genital ulcer

Answer 8

Syphilis

Question 9

Dx?Painful genital ulcer

Answer 9

Chancroid (Haemophilus ducreyi)

Question 10

Dx?Lymph nodes tender & suppurating + genital ulcer

Answer 10

Lymphogranuloma venereum

Question 11

Dx?Painful vesicles, leading to ulcer

Answer 11

Herpes simplex

Question 12

Syphilis – Dx tests?

Answer 12

Dark-field microscopy- CDRL or RPR (75% sensitive in primary syphilis)- FTA or MHA-TP (confirmatory)

Question 13

Chancroid (H. ducreyi) – Dx tests?

Answer 13

Stain & culture on specialized media

Question 14

Lympogranuloma venereum – Dx tests?

Answer 14

• Complement fixation titers in blood- Nucleic acid amplification testing on swab (PCR)

Question 15

Herpes simplex – Dx tests?

Answer 15

• Tzanck prep = best initial test- Viral culture = most accurate test

Question 16

Syphilis – Tx?

Answer 16

Single dose of intramuscular benzathine penicillin- Doxycycline in penicillin allergy(ulcers resolve on their own, Tx is to prevent further stages)

Question 17

Chancroid (H. ducreyi) – Tx?

Answer 17

Azithromycin (single dose)

Question 18

Lymphogranuloma venereum – Tx?

Answer 18

Doxycycline

Question 19

Primary syphilis – presentation?

Answer 19

• Painless genital ulcer w/ heaped-up INDURATED EDGES (becomes painful if secondarily infected w/ bacteria)- Painless adenopathy

Question 20

Secondary syphilis – presentation?

Answer 20

• Rash (palms & soles)- Alopecia areata- Mucous patches- Condylomata lata

Question 21

Tertiary syphilis – presentation?

Answer 21

Neurosyphilis:- Meningovascular (stroke from vasculitis)- Tabes dorsalis (loss of P & V sense, incontinence, cranial nerve)- General paresis (memory & personality changes)- Argyll Robertson pupil (reacts to accommodation but not light)- Aortitis (aortic regurge & aneurysm)- Gummas (skin & bone lesions)

Question 22

Syphilis Tx: If PCN-allergic, when do you desensitize to PCN instead of switching to Doxycycline

Answer 22

If neurosyphilis exists or if the patient is pregnant

Question 23

Condyloma Acuminata – what is it?

Answer 23

Genital warts (papillomavirus)

Question 24

Condyloma Acuminata – Dx test(s)?

Answer 24

Visual appearance alone

Question 25

Condyloma Acuminata -- Tx?

Answer 25

Remove w/ Cryotherapy w/ liquid nitrogen, surgery, laser, or "melting" w/ podophyllin or tricloroacetic acid- Imiquimod is a locally applied immunostimulant that leads to the sloughing off of the lesion

Question 26

Pediculosis

Answer 26

Crabs- found on hair bearing areas (axial, pubis)- Visible on surface- Causes itching

Question 27

Pediculosis -- Tx?

Answer 27

Permethrin(Pediculosis = Crabs)

Question 28

Scabies -- Dx test(s)?

Answer 28

Must scrape them out of the skin & magnify to Dx(b/c they burrow beneath the skin but leave a visible trail)

Question 29

Scabies -- Tx?

Answer 29

Permethrin

Question 30

Scabies -- where is it found?

Answer 30

Web spaces between fingers & toes or @ elbows or genitalia

Question 31

Pyelonephritis -- Tx?

Answer 31

- Ceftriaxone (1st), Ertapenem- Ampicillin & Gentamicin (if cultures are known)- Ciprofloxacin (oral for outpatient)** any drug for gram-negative rods would be effective **

Question 32

Prostatitis -- Tx?

Answer 32

- Ceftriaxone (1st), Ertapenem- Ampicillin & Gentamicin (if cultures are known)- Ciprofloxacin (oral for outpatient)** any drug for gram-negative rods would be effective **

Question 33

Chronic Prostatitis -- Tx?

Answer 33

TMP/SMX x 6-8 wks

Question 34

Isoniazid -- AEs?

Answer 34

- Neurotoxicity (prevented by pyridoxine, B6)- Hepatotoxicity- Lupus-like syndrome

Question 35

Rifampin -- AEs?

Answer 35

- Minor hepatotoxicity & drug interactions (inc's P450)- Orange body fluids (nonhazardous)

Question 36

Pyrazinamide -- AEs?

Answer 36

- Hyperuricemia- Hepatotoxicity

Question 37

Ethambutol -- AEs?

Answer 37

Optic neuropathy (red-green color blindness)

Question 38

What type of drugs end in "navir"?

Answer 38

Protease inhibitors

Question 39

What type of drugs end in "vudine"?

Answer 39

NRTIs (though not all of these end in "vudine")