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T2 Endo/Repro > IID 1 > Flashcards

IID 1 Flashcards

1
Q

Which main STIs produce sores? vs discharge?

A

sores- syphilis, HSV

discharge- gonorrhea, chlamydia, trichomonas vaginitis, candidiasis

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2
Q

which one produces painless sores?

A

syphilis

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3
Q

tests for syphilis

A

RPR, VRDL, darkfield fluorescence to find spirochetes
treponemal would be FTA-ABS
tests stay +

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4
Q 
primary syphilis
secondary
tertiary 
congenital
sx
A
  • prim- painless ulcer chancre
  • second- maculopapular rash and condyloma lata
  • tert- granulomatous gummas, neurosyphilis (w tabes dorsalis pupils dont react w light), CV aorta tree barking
  • congen- hutchinsons teeth, high mort, ocular issues
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5
Q

Tx for syphilis

A

PCN (purple pencil)

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6
Q

Haemophilis Ducreyi
sx
appearance on slides

A

PAINFUL chancroid genital ulcer, dis of tropics, satellite lesions, may be asymp in women

  • gram neg coccobacilli, needs hematin X factor and NAD V factor to culture on chocolate agar
  • histo: school of fish appearance
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7
Q 
Donvanosis/ granuloma inguinale
org
sx 
histo
pop
A
  • klebsiella (gram neg encaps rod)
  • bacteria looks like SAFETY PIN, intracellular donovan bodies in smear preps for dx
  • endemic to tropics/travelers
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8
Q

Genital herpes simplex (usu HSV2)

A

latency in neural ganglia, reactivation infxn, torches
-histo: tzanck smear with multinucl giant cells and COWDRY bodies in skin biopsies
(“Hermes”)

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9
Q

Neisseria gonnorhoeae
VFs
sx

A

pili, igA protease, with lots of ag variation, abx res, no capsule

  • sx: PID, neonatal conjunctivitis (Tx with abx), dx with smear and naats, tx with 3rd gen cef (and tx with azithro for chlam)
  • discharge
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10
Q

Chlamydia Trachomatis
VFs
dx
tx

A
  • vf: intracell, lacks peptidoglycan thus no muramic acid, biphasic rep cycle (elementary enters)
  • dx with NAAT, pcr etc, look for incl bodies
  • tx with Azithro and doxy
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11
Q

chalmydia sx

A
  • PID, infert/ectopic etc

- L serovar causes LGV painless ulcer, and boboes (lymph swelling)

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12
Q

Trichomonas vaginalis
sx
tx
histo

A

“Tricks for Money” –trophozoite transm

  • higher pH, frothy greenish yellow discharge, STRAWBERRY CERVIX!
  • tx: metronidazole
  • histo: wet mount will show trophozoites (puddle shape, these teardrop shaped creature things w/ motility)
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13
Q

Which HPV types are higher risk and can cause cervical cancer?

A

16 and 18

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14
Q 
Bacterial vaginosis
org
dx
histo
sx
A

“The Fish Garden”
Gardnerella and other anaerobes
-FOUL SMELLING discharge due to anaerobes, ph 4.5 and up, Clue cells from vag epith with bacteria (blue looking spots where missing fish were in sketchy_
-can cause PID and preg issues

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15
Q

Candida albicans
risks
ph
sx

A

Germ tubes at higher temp, yeast/pseudohyphae at lower temp, imbalance of normal vaginal

  • risks: fem hygeine products, ABX, DM
  • ph LESS than 4.5
  • cottage cheese white discharge, itching etc
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16
Q

Pubic lice tx

Scabies sx and tx

A
  • lice- permethrin
  • scabies- skin rash in folds, itch gets worse at night, tx with topical pesticides etc

both can be from sexual contact

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17
Q

which STI can lead to meningitis and stiff neck?

A

HSV!

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18
Q

other HPV sx, histo

A

small painless lesions that bleed after sex, koilocytes (blue sunny side up eggs from sketchy) on histo

  • vax: gardenesil
  • E6 and 7
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19
Q

haemophilis d tx

A

CEF and AZITHRO (like gon/chlam)

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20
Q

klebsiella tx

A

tetracyline (donovanosis, tropical)

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21
Q

Main TORCH infections

A 
Toxoplasmosis
Other (syphillis, varicella zoster, parvovirus b19)
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22
Q

Toxoplasmosis

A

org is toxoplasma gondii, cats are hosts, cat poop has oocysts which need to sit out for a few days to become infective (humans can also get it from meat this way etc or eating stuff off the floor)

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23
Q

Toxo in pregnancy and dev countries etc

A
  • preg women can get it from changing cat litter
  • in developing countries, congenital infxn is less likely bc kids get it so become immune, congen toxo only occurs if preg woman gets infxn for first time (ppl exposed in childhood cant pass it on)
  • the earlier preg woman gets infection, the less likely to pass it on yet the more severe!
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24
Q

Classic triad of congen toxo?

A

Chorioretinitis
Intracranial calcs
Hydrocephalus (CSF accum)
-long term CNS issues incl cog vis motor hearing or seizures

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25
Q

preventing toxo

A

no regular screning but can dx with sero or pcr

-freeze or smoke/cook food, avoid cat poop contact

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26
Q

Syphilis transmission rate

A

from mother to fetus is 100%

27
Q

some congen syphilis sx

A

prematureity, spont abortion or stillbirth etc

28
Q

syphilis sx if affected EARLY in preg

A 
maculopapular RASH!!!
hepatosplen
nontender lymphaden
anemio/thrombocyto/leukopenia
osteo issues
neurosphilis
snuffles/rhinitis
29
Q

syphilis sx if affected LATE in preg

A

Deafness from CN 8
Interstitial keratitis (inflamed cornea)
MR
HUTCHINSONS TEETH (adult teeth tho)

30
Q

if untreated, congen syphilis can result in

A

frontal bossing, saddle nose, saber shins (tibia anterior bowing)

31
Q

Tests for syphilis nontrep and trep

A

nontrep- RPR, VDRL

trep-TPPA, FTA-ABS etc

32
Q

if testing for syphilis in infant, which test?

A

RPR on mom and baby, if babys rpr is at least 4x higher than mothers, sus for syphilis

33
Q

tx for syphilis

A

PEN!

-can screen preg women unlike with toxo

34
Q

Varicella Zoster

  • is infxn primary?
  • percent that will get infxn
  • which trimester most infectious
A
  • infxn must be primary (so shingles aka reactivation will not infect bby)
  • 25% of cases fetus will get infected tho only 2-3% show up clinically
  • 1st tirmester most infectious
35
Q

congen varicella sx

A

skin lesions/scars, atrophied limbs, eye/cns issues, autonomic issues (hydroureter/gastric reflux etc)

36
Q

How to prevent congen varicella? How does it spread

A

vax mother, give immune globin to primary infected mother and acyclovir, none for infants
-spreads as aerosol (inhaled), replicates in lymph nodes

37
Q

when can neonatal infxn of varicella show?

A

if mother shows infection 5 days before or 4 d after birth

38
Q

neonatal varicella sx

A 
GENERALIZED ERUPTION (rash)
fever
encephalitis
pneumonitis
hepatitis
39
Q

Varicella vax

A

LIVE so dont give to preg women

40
Q

Parvovirus B19

  • percent transmission to fetus
  • what can happen if transmitted to fetus
A

30% transmission

  • can get hydrops fetalis (bone marrow suppression causing severe anemia and cardiac failure, resulting in edema and effusions), or miscarry, can be detected via ultrasound
  • no specific tx but can use intrauterine blood transfusions
41
Q

Rubella can cause?

A

congen can cause miscarriage or congen anomalies, bc virus can cause progressive necrotizing vasculitis and focal inflam

42
Q

rate of transmission of rubella early vs late in preg

A

more likely to get rubella EARLY AND more severe!

43
Q

congen rubella sx

A 
Blueberry muffin baby
low birth rate, thrombo purpura
hepatosplenomeg
radiolucent bone lesions
(less common are hep, lymphad, pneum, hemo anemia, cloudy corneas)
44
Q

how long to babies with congen rubella remain infectios and what can sx progress to?

A

thru 1 yr

progressive sx affect cv, nervous, and unilateral retinopathy and cataracts

45
Q

congent rubella tx

vax?

A

no tx!

vax is LIVE mmr, so dont give to preg women bc coudl transm to bby

46
Q

CMV

likelihood of transm

A

most common!
-40% transm to baby, but 90% asymp, soem get CNS issues, but if symp then usu severe disease with 12% mort by 6 mo w intrauterine growth restriction

47
Q

CMV trimester timing, immunity, dev countries

A
  • can occur at ANY point during preg AND with reactivation! (doesn’t have to be primary), though much LESS SEVERE if reactivation)
  • unlike toxo, MORE likley to get it in developing countries
48
Q

Sx of symptomatic CMV

A

neuro, microceph, lethargy, seizures

  • hypotonia, poor sucking ability
  • INTRACRANIAL CALCS
  • can also have longer term rash/petechia, jaundice and hepatosplen, and blueberry muffin rash (like rubella)
49
Q

which congen infections cause blueberry muffin baby?

A

rubella and CMV

50
Q

lab values of congen CMV

A

elev liver eynz, thromobcytopenia, conj hyperbili, hemolysis, incr CSF

51
Q

Which virus is the leading cause of SENSORINEURAL DEAFNESS and second leading cause of dev disability?

A

CMV!

52
Q

tx of cmv

A

GANCYCLOVIR

no vax, no routine screen

53
Q

HSV

transmission in preg

A

The H in torch! (NOT hiv)

  • happens to bb when born thru vaginal, if mother has primary infx risk is 1/3-1/2, latency is 0-5%
  • 75% of bby with neonatal HSV are born to mothers with NO history or sx of HSV
54
Q

Neonatal hsv manifestations

A
  • DISSEM infection (1/4) with sepsis liver and cns, 50% mort even with tx, more common if mom has prim infxn at delivery
  • 35% have solely CNS, 15% mort, and those that survive have neuro issues
  • some have localized infxn at skin eye and mouth, ,but good outcome if dx and tx early
55
Q

HSV tx

A

acyclovir for women during preg, or C section

56
Q

Other congenital infections (non torch)

A

HIV

Neonatal gono and chalm

57
Q

HIV congen transm
sx
dev countries

A

thru birht and breastfeeding

  • sx are intrauterine grwoth restriction, adeno, hepatosplen, opportunistic
  • still recommend breastfeeding in dev countries bc water contamination higher (diarr)
58
Q

Neonatal gonococcal disease

sx and timing

A

opthalmia neonatorum with severe purulent CONJUNCTIVITIS 2-5 d after birth (can also happen with chlam, moraxella, or neisseria)
-sepsis, arthritis, ifnlam

59
Q

Neonatal chlamydia

A

ALSO opthalmia neonatorum 5-30 d (LATER and less ssevere conjunctivitis) and infantile pneum motnhs after with tachy and eosin

60
Q

toxo tx

A

pyramethamine and sulfadiazine

61
Q

neonatal vs congen rubella sx

A

congen is skin lesions scars atrophy cns and eye autonomics, neonatal is fever and generalized eruption enceph pneumo and hep
-tx acyclovir for NEONATAL

62
Q 
Tx for
Toxo
Syphilis
Varicella
Parvo
CMV
HSV
A 
toxo- sulf and pyrameth
-syphilis- pen
varicella - acyclocvir for neonatal
CMV- gancyclovir
HSV- acyclovir (like neonatal varicella)
63
Q

3 dis manifestatiosn of HSV

A

dissem,solely CNS, localized infxn of skin eye mouth

64
Q

diff in sx between neonatal gono and chlam

A

gono-2-5 d and has inflam / sepsis

chlam- 5-30 d and has pneum

T2 Endo/Repro (11 decks)

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