infection

Question 1

Condylomata acuminata (genital warts)

Answer 1

ETI
-HPV 6 and 11

CLINICAL

• multiple pink or skin colored lesions
• lesions can be smooth, flattened papules
• exophytic/cauliflower growths
• friable

TREAT

• chemical: podophyllin resin, trichloracetic acid
• immunologic: imiquimod
• surgical: cryotherapy, laser therapy, excision

PREVENTION

• vaccination
• barrier contraception

Question 2

Pelvic inflammatory disease

Answer 2

RISK

• being less than 25
• having sex without barrier methods

Symptoms

• lower abdominal pain
• abnormal bleeding
• perihepatitis –> liver capsule inflammation –> vomiting
• RUQ pain

PE

• cervical motion tenderness
• fever
• mucopurulent cervical discharge

Treatment

• third gen ceph and
• azithromycin or doxycycline

COmplications

• tubo-ovarian abscess
• infertility
• ectopic pregnancy
• perihepatitis

Question 3

Hidradenitis suppurativa

Answer 3

DEF

• chronic inflammatory condition
• involves recurrent occlusion of hair follicles in intertiginous regions

RISK

• age 20-40
• obesity
• tobacco use
• family history

CLINICAL

• initially a solitary painful nodule surrounding a follicle
• develops into a spontaneously draining abscess
• chronic and progressive
• can develop sinus tract and scar formation

Question 4

intrauterine adhesions

Answer 4

PATHOPHYS

• intrauterine synechiae development
• Asherman syndrome

RISK

• infection: septic abortion, endometritis
• intrauterine surgery (curretage, myomectomy)

CLINICAL

• AUB
• amenorrhea
• infertility
• cyclic pelvic pain
• recurrent pregnancy loss

EVAL
-hysteroscpy

Question 5

Genital herpes

Answer 5

• multiple painful ulcers
• small vesicles or ulcers on erythematous base
• tender inguinal lAD
• dysuria
• sterile pyuria
• acute urinary retention

Question 6

vulvar lichen sclerosis

Answer 6

EPI
-prepubertal girls and perimenopausal or post menopausal women

CLINICAL

• thin, white, wrinkled skin over the labia
• atrophic changes that extend over the perineum and around anus
• excoriations, erosions, fissures from severe pruritus
• dysuria, dysparenia, painful defecation

WORK UP
-punch biopsy of adult-onset lesions to exclude malignancy

TREAT
-super-potent corticosteroid ointment

Question 7

Indications for hospitalization for PID

Answer 7

• pregnancy
• failed outpatient treatment
• inability to tolerate oral medications
• noncompliant with therapy
• severe presentation with high fever and vomiting
• complications: tubo-ovarian abscess, perihepatitis

Question 8

asymptomatic bacteriuria

Answer 8

DEF
-over 100,000 bacteria

RISK

• pre gestational DM
• history of urinary tract infection
• multiparity

Common pathogens

• e coli
• klebsiella
• enterobacter
• GBS

TREAT

• cephalexin
• amox-clav
• nitrofurantoin
• fosfomycin

Question 9

Chlam and gonorrhea

Answer 9

RISK

• less than 25 (ALL should be screened)
• high risk sexual behavior

MANIFESTATIONS

• asymptomatic
• cervicitis
• urethritis
• perihepatitis (fitz-hugh-curtis)

DIAGNOSIS
-NAT

TREAT

• empiric: azithro, and CTX
• confirmed chlam: azithro
• confirmed gon: azithro and CTX

COMPLICATIONS

• PID
• ectopic preg
• infertility

Question 10

Vulvar lichen planus

Answer 10

CLINICAL

• women age 50-60
• vulvar pain or pruritis
• dyspareunia

Erosive varient

• erosive, glazed lesions with white border
• vaginal involvement +/- stenosis
• associated oral ulcer

Papulosquamous variant
-small pruritic papules with purple hue

DIAGNOSIS
-vulvar biopsy

TREATMENT
-high potency topical corticosteroids