Infecciones ginecológicas

Question 1

pH vaginal normal

Answer 1

4-4.5

Question 2

Bacterias que aumentan crecimiento en vaginosis bacteriana

Answer 2

Gardnerella vaginalis, Ureaplasma urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species

Question 2

Bacterias que aumentan crecimiento en vaginosis bacteriana

Answer 2

Gardnerella vaginalis, Ureaplasma urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species

Question 3

Células características en vaginosis bacteriana

Answer 3

células diana (clue cells) 20%

Question 4

Esquema de tx de vaginosis bacteriana

Answer 4

Recommended regimens
Metronidazole (Flagyl) 500 mg orally twice daily for 7 days
Metronidazole gel 0.75% (Metrogel vaginal) 5 g (1 full applicator) intravaginally once daily for 5 days
Clindamycin creama 2% (Cleocin, Clindesse) 5 g (1 full applicator) intravaginally at bedtime for 7 days

Alternative regimens
Tinidazole (Tindamax) 2 g orally once daily for 2 days
Clindamycin 1 g orally once daily for 5 days
Clindamycin ovulesa (Cleocin)100 mg intravaginally at bedtime for 3 days

Question 5

Estados de lesiones de HSV

Answer 5

(1) vesicle with or without pustule
formation, which lasts approximately a week; (2) ulceration; and (3) crusting.

Question 6

Estados de lesiones de HSV

Answer 6

(1) vesicle with or without pustule
formation, which lasts approximately a week; (2) ulceration; and (3) crusting.

Question 7

Gold standard para el dx de HSV

Answer 7

gold standard or the diagnosis o genital herpes is tissue culture.

Question 8

Tx HSV

Answer 8

First clinical episode
Acyclovir 400 mg three times daily for 7–10 days
Famciclovir (Famvir) 250 mg three times daily for 7–10 days
Valacyclovir (Valtrex) 1 g twice daily for 7–10 days

Episodic therapy for recurrent disease
Acyclovir 400 mg three times daily for 5 days
Famciclovir 125 mg twice daily for 5 days
Valacyclovir 500 mg twice daily for 3 days

Suppressive therapy
Acyclovir 400 mg twice daily

Question 9

Estados de sífilis

Answer 9

Primary syphilis, the hallmark lesion is the chancre, in which spirochetes are abundant. Nontender ulcer.

Secondary syphilis, bacteremia develops 6 weeks to 6 months a ter a chancre appears. Its hallmark is a maculo-papular rash that may involve the entire body and includes the palms, soles, and mucous membranes. As is true or the chancre, this rash actively sheds spirochetes. With highly infectious plaques called condylomata lata.

Tertiary syphilis is the phase o untreated syphilis that may appear up to 20 years after latency. During this phase, cardiovascular, CNS, and musculoskeletal involvement become apparent

Question 10

Esquema de tx de sífilis

Answer 10

Primary, secondary, early latent (< 1 year) syphilis
Recommended regimen:
Benzathine penicillin G, 2.4 million units IM once Alternative oral regimens (penicillin-allergic,
nonpregnant women): Doxycycline 100 mg orally twice daily for 2 weeks

Late latent, tertiary, and cardiovascular syphilis
Recommended regimen:
Benzathine penicillin G, 2.4 million units IM weekly times
3 doses
Alternative oral regimen (penicillin-allergic, nonpregnant
women): Doxycycline 100 mg orally twice daily for 4 weeks

Question 11

Tratamiento chancroide

Answer 11

regimens or nonpregnant women include single doses o oral azithromy- cin (1 g) or IM ceftriaxone (250 mg).
Multiple-dose options are ciprofloxacin 500 mg orally twice daily or 3 days of erythromycin base 500 mg orally three times daily or 7 days.

Question 12

Diagnóstico de granuloma inguinal

Answer 12

Diagnosis by identication of Donovan bodies during microscopic evaluation of a specimen following Wright- Giemsa staining.

Question 13

Tratamiento de granuloma inguinal

Answer 13

Recommended regimen
Azithromycin (Zithromax) 1 g once weekly for at least 3 weeks and until lesions are completely healed
Alternative regimens
Doxycycline 100 mg twice daily as above

Question 14

Serotipos en linfogranuloma venéreo

Answer 14

L1, L2 L3

Question 15

Estados de linfogranuloma venéreo

Answer 15

three stages: (1) small vesicle or papule, (2) inguinal or emoral lymphadenopathy, and (3) anogeni- torectal syndrome.

Question 15

Estados de linfogranuloma venéreo

Answer 15

three stages: (1) small vesicle or papule, (2) inguinal or emoral lymphadenopathy, and (3) anogeni- torectal syndrome.

Question 16

Tx de linfogranuloma venéreo

Answer 16

doxycycline,100 mg orally twice daily for 21days

Question 17

Definición de candidiasis recurrente

Answer 17

4 eventos o más al año

Question 18

Tx de candidiasis recurrente

Answer 18

For recurrent C albicans disease, local intravaginal therapy or 7 to 14 days or oral uconazole (Di ucan) in 100-mg,
150-mg, or 200-mg doses once every third day or a total o three doses (day 1, 4, and 7) are options. Suppressive main- tenance regimen or recurrence prevention is oral uconazole, 100 to 200 mg weekly or 6 months.
Non-albicans candidal species are not as responsive to topical azole therapy. For non- albicans recurrent infection, a 600-mg boric acid gelatin capsule intravaginally daily or 2 weeks has been success ul.

Question 19

Tx trichomoniasis normal y resistente

Answer 19

metronidazole 2 g once or tinidazole 2 g once
resistente: oral tinidazole at doses o 500 mg orally three times daily or 7 days or our times daily or 14 days

Question 20

Tx de gonorrea normal y alergia a cefalosporinas

Answer 20

ceftriaxone 250 mg IM + azithromycin 1 g orally once
gemifloxacin 320 mg plus azithromycin 2 g

Question 21

Tx de clamidia

Answer 21

Azithromycin 1 g once
Doxycycline 100 mg twice daily for 7 days

Question 22

Tratamiento de Mycoplasma genitalum

Answer 22

azithromycin 1 g orally once is recommended.

Question 23

Organismos asociados a EPI

Answer 23

N gonorrhoeae, C trachomatis, T vaginalis.

Question 24

Diagnóstico de EPI

Answer 24

uterine tenderness, adnexal tenderness, or cervical motion tenderness is present. One or more o the following enhances diagnostic specicity: (1) oral temperature > 38.3°C (101.6°F), (2) mucopurulent cervical discharge or cervical friability, (3) abundant WBCs on saline microscopy o cervical secretions, (4) elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and (5) presence cervical N gonorrhoeae or C trachomatis.

Question 25

Hallazgos us EPI

Answer 25

1) trompa de forma ovoide y distendida llena de líquido anecoico o ecógeno; 2) engrosamiento de la trompa de Falopio; 3) tabiques internos incompletos, y 4) aspecto de “rueda dentada” de las trompas inflamadas cuando se les estudia en corte transversal

Question 26

Hallazgos de ATO

Answer 26

afected women display signs o PID and a concurrent adnexal or cul-de-sac mass. Sonographically, with OA, a complex cystic adnexal or cul-de-sac mass with thick irregular walls, areas o mixed echogenicity, septations, and
internal echoes rom debris is seen

Question 27

Tx iv de EPI

Answer 27

Cefotetan (Cefotan) 2 g IVevery 12 hr or
Cefoxitin (Mefoxin) 2 g IVevery 6 hr PLUS
Doxycycline 100 mg orally or IVevery 12 hr

Clindamycin 900 mg IVevery 8 hr
PLUS
Gentamicin loading dose 2 mg/kg IVor IMfollowed
by a maintenance dose of 1.5 mg/kg every 8 hr. Single daily dosing at 3 to 5 mg/kg per day may be substituted.

Alternative regimen
Ampicillin/sulbactam (Unasyn) 3 g IVevery 6 hr PLUS
Doxycycline 100 mg orally or IVas above

Question 28

Casos en los que se debe de retirar un DIU por EPI

Answer 28

enfermedad grave
no mejoría después de 48-72 horas

Question 29

Indicaciones de tx parenteral

Answer 29

Pregnant
Adolescents
Drug addicts
Severe disease
Suspected abscess
Uncertain diagnosis
Generalized peritonitis
Temperature > 38.3°C
Failed outpatient therapy
Recent intrauterine instrumentation
White blood cell count > 15,000/mm3 Nausea/vomiting precluding oral therapy

Question 30

Tx ambulatorio de EPI

Answer 30

Ceftriaxone (Rocephin) 250 mg IM oncea,b
PLUS
Doxycycline 100 mg orally twice daily for 14 days with or without
Metronidazole (Flagyl) 500 mg orally twice daily for 14 days

Question 31

Sitios más frecuentes de escabiasis

Answer 31

hands, wrist, elbows, groin, and ankles

Question 32

Principal manejo de absceso de glándula de Bartolino

Answer 32

drenaje

Question 33

Criterios de dx de síndrome de shock tóxico

Answer 33

** To meet the strict criteria, a woman must have all major and at least three minor criteria.
Major criteria
Hypotension
Orthostatic syncope
Systolic BP < 90 mm Hg for adults
Diffuse macular erythroderma
Temperature ≥ 38.8°C
Late skin desquamation, particularly on hands, palms, and soles (1–2 weeks later)

Minor criteria (organ system involvement)
Gastrointestinal: diarrhea or vomiting
Mucous membranes: oral, pharyngeal, conjunctival, and/or vaginal erythema
Muscular: myalgia or creatinine level greater than twice normal
Renal: BUN and creatinine greater than twice normal or > 5 WBCs/hpf in urine, without concurrent UTI Hematologic: platelet count < 100,000 per mm3
Hepatic: SGOT, SGPT, and/or bilirubin levels greater than twice normal
Central nervous system: altered consciousness without focal localizing signs

Question 34

Clasificación de infecciones de heridas qx

Answer 34

Superficial incisional
Deep incisional
Organ/space

Question 35

Clasificación de infecciones de heridas qx

Answer 35

Superficial incisional
Deep incisional
Organ/space

Question 36

Manejo de absceso de glándula de Bartolino

Answer 36

drenaje