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Women's Health EOR > Infections > Flashcards

Infections Flashcards

1
Q

Vaginal Ecosystem

  1. what type of pH is normally present in the vagina
  2. what organism maintains the normal pH of the vagina
A

Vaginal Ecosystem

  1. acidic pH in the vagina = normal
  2. Lactobacilli maintains normal pH of the vagina
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2
Q

Wet Mount

- What 4 things/diseases can be identified

A

Wet Mount: can identify

  1. Clue cells (BV)
  2. Pseudohyphae (Candidasis)
  3. Trichomonads (Trich)
  4. WBCs + RBCs `
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3
Q

What is the #1 cause of vaginitis?

A

1 cause of vaginitis = BV

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4
Q
  1. What type of vaginitis occurs when there’s decr lactobacilli –> overgrowth of norm flora
  2. what MC bacteria = cause
A
  1. decr lactobacilli –> overgrowth of bacteria = BV (Bacterial Vaginosis)
  2. MC bacteria for BV = Gardnerella Vaginalis
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5
Q

25 y/o F presents w/ increased discharge. She has had multiple sex partners, has had unprotected sex, and started seeing someone new a few weeks ago. She smokes and douches. On PE you notice copious, thin grey d/c non-adherent to the vaginal wall and a fishy odor.

  1. Dx?
  2. What do you expect KOH whiff test to be?
  3. What do you expect to see on wet mount?
  4. What do you expect pH to be?
A
  1. Dx = BV
    • KOH whiff test
  3. wet mount –> clue cells w/ fuzzy borders
  4. pH > 4.5
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6
Q

BV Dx & Tx

  1. What is the gold std for Dx?
  2. What are 3 options for 1st line Tx for BV
  3. What is Tx for pregnant women
A

BV Dx & Tx

  1. gold std for Dx = gram stain
  2. 1st line Tx for BV
    - Metronidazole (PO or topical applicator)
    - Clindamycin (Topical cream)
  3. Tx for pregnant women = PO Metronizadole (PO Clindamycin)
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7
Q

Tx of BV

  1. what pt edu must you give for pts on PO Metronidazole
  2. Do you need to treat the partner?
A

Tx of BV

  1. PO Metronidazole –> NO ETOH (disulfiram-like rxn)
  2. DO NOT need to treat the partner
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8
Q
  1. What type of vaginitis in pregnancy increases risk of PPROM, preterm delivery + chorioaminionitis
  2. What should be done 1 month after Tx completion
A
  1. BV in pregnancy –> increase risk of PPROM, preterm delivery + chorioaminonitis
  2. 1 month after Tx completion –> test of cure
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9
Q

Vaginitis: Candidiasis

  1. What is MC organism/cause
  2. what type of d/c is a/w it
  3. what is pH a/w it
  4. What is expected on wet mount w/ KOH prep
  5. What is general Tx
A

Vaginitis: Candidiasis

  1. MC organism/cause = Candida albicans
  2. thick, cottage cheese d/c
  3. normal pH (differs from BV)
  4. wet mount w/ KOH prep –> pseudoyphae + spores
  5. general Tx = -azoles
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10
Q

Pt presents w/ vulvar pruritus, burning/irritation, dysuria, dyspareunia. Pt admits to recent ABX use, h/o DM + douching. On PE you note thick, white cottage cheese d/c. On Wet mount w/ KOH prep you see pseudohyphae w/tree branch appearance

Dx?

A

Dx = Candidiasis

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11
Q

Candidiasis Tx

  1. What is the PO drug give (x 1 dose, 150 mg)
  2. What edu must you give pts if prescribing topical -azoles (Ex: Miconazole/Monistat)
  3. How does Tx differ for recurrent/complicated Candidiasis?
  4. Should you always Tx if a women is pregnant? What is Tx/type (2)
  5. What is Tx for C. glabrata
A
  1. PO drug = Fluconazole/Diflucan (x 1 dose, 150 mg)
  2. Topical -azoles (Ex: Miconazole/Monistat) –> no sex
  3. Tx for recurrent/complicated Candidiasis = longer
  4. ONLY Tx pregnant women if symptomatic
    - TOPICAL Clotrimazole or Miconazole
  5. Tx for C. glabrata = PO Boric acid —> inserted into vagina x 14 days
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12
Q

Pt presents c/o profuse vaginal d/c that is worse w/ menses, dyspareunia, dysuria, + vulvar pruritus/erythema. On PE you note frothy yellow/green d/c and a strawberry cervix.

Dx?

A

Dx = Trichomonas

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13
Q

Trichomonas Dx/Tx

  1. What expected on wet mount
  2. What is 1st line Tx (including dose)
  3. Should the partner be treated/why
A

Trichomonas Dx/Tx

  1. Wet mount –> MOTILE organism w/flagella
  2. 1st line Tx = 2 g of Metronidazole PO x 1
  3. YES partner must be treated b/c transmitted sexually
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14
Q

What 4 STIs should all pregnant women be screened for

A

STI screening in pregnancy

  1. Syphillis
  2. HIV
  3. Chlamydia
  4. HBV
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15
Q

What are the only 2 organisms that cause mucopurulent cervicitis

A

only 2 organisms that cause mucopurulent cervicitis

  1. Neisseria gonorrhoeae
  2. Chlamydia Trachomatis
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16
Q

Other causes of Cervicitis:

  1. What types of lesions does HSV cause (2 options)
  2. What types of lesions does HPV cause + what is there risk of?
A

Other causes of Cervicitis:

  1. HSV –> herpes lesion or white plaque resembling cervical CA
  2. HPV –> condylomata + risk of cervical CA
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17
Q

What type of infxn is caused by an obligate intracellular parasite? –> therefore what test often used to Dx (cultures poorly)

A

Chlyamida infxn

- caused by an obligate intracellular parasite –> NAAT (DNA test) used to Dx b/c cultures poorly

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18
Q

What is the MC presentation for both men + women w/ Chlamydia?

Other presentations:

  • urethritis (both)
  • cervicitis (F)
A

MC presentation for both men + women w/ Chlamydia = NONE (most Asx)

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19
Q

Complications of Chlamydia

  1. 3 in men
  2. 3 in women
A

Complications of Chlamydia

  1. Men = epididymitis, prostatitis, proctitis
  2. Women = endometritis (late PPD), salpingitis, PID
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20
Q

What is the main cause of PID + sterility in women

A

main cause of PID + sterility in women = Chlamydia

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21
Q

First line tx for Chlamydia

  1. what 2 things can it cause in infants
  2. what other infxns/dz can it cause
A

Chlamydia

  1. infants –> neonatal conjuctivitis or PNA
  2. can cause pharyngitis or reactive/aseptic kkarthritis
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22
Q

Chlamydia Tx

  1. First line tx
  2. Why can Tetracylines not be used in pregnant women
A

Chlamydia Tx

  1. 1st line = 1 g Azithromycin PO x 1
  2. Tetracyclines CI in pregnancy –> stains babies teeth
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23
Q

What type of organism a/w gram (-) intracellular diplococci

A

gram (-) intracellular diplococci = Gonorrhea

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24
Q

Transmission of Gonorrhea/in Neonates

  1. 3 ways to reduce risk (during sex)
  2. what type of transmission MC
  3. what dz does it cause in newborns
A

Transmission of Gonorrhea

  1. reduce risk w/ condoms, spermicides, diaphragms
  2. male –> female transmission = MC
  3. newborns –> conjuctivits
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25
Q

3 Complications of Gonorrhea

A

3 Complications of Gonorrhea (ascending infxns)

  1. endometritis
  2. Salpingitis/PID,
  3. TOA (tubo-ovarian abscess)
26
Q

pt presents c/o mucopurulent vaginal d/c, post coital spottin and dysuria. on PE you notice arthritis in knee and painful pustules on skin

Dx (specific)

A

Dx = disseminated gonococcal dz

27
Q

Dx + Tx of Gonorrhea

  1. best way to Dx
  2. what other Dx test helpful for ruling in Gonorrhea but not good for Chlamydia?
  3. Tx
A

Dx + Tx of Gonorrhea

  1. best way to Dx = NAAT
  2. Dx test helpful for ruling in Gonorrhea but not good for Chlamydia = Gram stain
  3. Tx = 250 mg IM Ceftriaxone AND 1 g Azithromycin PO x1
28
Q

What is the MC cause of PID

A

MC cause of PID = G/C

29
Q

Pt presents c/o pelvic/abd pain, dysuria, dyspareunia, N/V, and mucopurulent d/c. On PE pt has fever of 38.5, adenexal tenderness, and CMT. Labs reveal elevated WBCs (19.0) and ESR (20).

Dx?

30
Q

Another name for cervical motion tenderness

A

CMT = Chandelier’s sign

31
Q

Dx of PID

  1. what method = gold standard
  2. What type of agar used for culturing
  3. 3 main Dx criteria
    (hint types of tenderness)
A

Dx of PID

  1. PCR/NAAT = gold standard
  2. Chocolate agar used for culturing
  3. 3 main Dx criteria
    - Abd/pelvic tenderness
    - Adnexal tenderness
    - CMT
32
Q

Tx of PID

  1. what is the outpatient Tx (2 drugs, +/- 1 other)
  2. What 2 drugs combos (2 drugs each) are inpt Tx
    - which is used during preg
A

Tx of PID

  1. Outpatient Tx (2 drugs, +/- 1 other)
    - IM Ceftriaxone 250mg + Doxycycline 100 mg BID x 14 days
    - +/- Metronidazole 500mg BID x 14 days
  2. 2 drugs combos (2 drugs each): inpt Tx
    - IV Cefotetan + PO Doxycycline x 14 days
    - Gentamicin + Clindamycin (used during preg b/c tetracyclines CI)
33
Q

Complications of PID

  1. what are the 2 main long term complications
  2. Name complication that causes hepatitic fibrosis/scarring –> RUQ pain that may radiate to the R shoulder, incr LFTs and violin string adhesions on liver
A

Complications of PID

  1. infertility + ecotopic preg = long term complications
  2. Fitz-Hugh Curtis Syndrome
    - hepatitic fibrosis/scarring –> RUQ pain that may radiate to the R shoulder, incr LFTs and violin string adhesions on liver
34
Q

PID risk factors

  1. What type of birth control incr risk of PID
  2. What type of birth control decr risk of PID
A

PID risk factors

  1. IUD –> incr risk
  2. OCPs –> decr risk
35
Q

Chancroid

  1. what organism causes it
  2. where do ulcers appear on female genitalia
A
  1. Cause of chancroid = Haemophilus ducreyi
    - gram (-) rod
  2. On females –> vulvar ulcers
36
Q

Male pt presents w/ single painful, demaracated, non-indurate ulcer w/ inguinal LAD in the angogenital region. Pt states the lesion began as tender papule w/ surrounding erythema. Gram stain shows school of fish pattern

Dx ?

A

Dx = Chancroid

37
Q

Tx of Chancroid

what are the 4 Tx options (no dosing)

A

4 Tx options for Chancroid = “ACCE”

  1. Azithromycin
  2. Ceftriaxone
  3. Cipro
  4. Erythromycin
38
Q

What is the systemic form of Chlamydia called that is caused by the L-serotypes of Chlamydia

A

LGV/Lymphogranuloma Venereum

- systemic form of Chlamydia, caused by the L-serotypes

39
Q

Pt presents c/o of painful inguinal LNs. Few days earlier pt states they noticed a soft, painless papule/ulcer on their genitalia/rectum that had pus underneath. Pt also noted Sxs of fever, malaise, HA and anorexia. Samples of LNs taken for culture, NAAT and immunofluorescence

Dx?
Tx? (2 ABX options, for how many days)

A

Dx = LGV (Lymphogranuloma Venereum)

Tx = Doxycycline (100 mg BID) or Erythromycin (500 mg QID) x 21 days

*doses for reference

40
Q

What disease has the following:

  • proctolitis
  • rectal stricture
  • recovaginal fistula
  • elephantasis
A
  • proctolitis
  • rectal stricture
  • recovaginal fistula
  • elephantasis

All characteristic of LGV (tertiary stage)

41
Q

What organism causes syphilis?

What is the appearance of the organism?

A

Cause of syphilis = Treponema pallidum

- spirochete (“cork screw” appearance)

42
Q

Name for the initial lesion of Syphilis

- painless, red, round, firm papule –> ulcer w/raised borders, a/w regional LAD

A

Initial lesion of Syphilis = Chancre
- PAINLESS, red, round, firm papule –> ulcer w/raised borders, a/w regional LAD

note: Chancroid = painful

43
Q

Pt presents w/diffuse bilateral maculopapular rash on palms and soles. Some of the papules have coalesced and formed gray-white, greasy plaques that are wart like. On PE you notice enlarged epitrochlear nodes

Dx/stage?
Name for coalesced papules –> gray-white, greasy plaques/wart-like lesions

A

Dx = Secondary Syphilis

Coalesced papules –> gray-white, greasy plaques/wart-like lesions = Condylomata lata

44
Q

Four characteristic things seen with/types of tertiary syphilis

A

Tertiary Syphilis

  1. Neurosyphilis
  2. CV Syphilis
  3. Argo Robertson pupil
  4. Gummas
45
Q

Pt presents w/ HA, meningitis signs, dementia, vision/hearing loss, incontinence and ataxia, areflexia, burning pain, and weakness.

What stage/type of syphilis is this

A

Dx = Neurosyphilis

- stage = tertiary

46
Q

demyelination of dorsal root ganglia –> ataxia, areflexia, burning pain, and weakness

A

demyelination of dorsal root ganglia –> ataxia, areflexia, burning pain, and weakness = Tabes dorsalis

a/w Neurosyphilis

47
Q

What are gummas in tertiary syphilis

A

Gummas = granulomas on skin and tissues
- Ex: bones

Note: not cancerous

48
Q

Pt comes in and on PE you note a small irregular pupil that constricts w/ near accommodation but not w/light

  1. name for this
  2. what dz is this sign a/w (+ stage)
A

small irregular pupil that constricts w/ near accommodation but not w/light

  1. called Argo-Robertson pupil
  2. a/w Syphilis (tertiary)
49
Q

CV Syphilis (tertiary)

  1. name of d/o that causes aortitis, aneuryms, and aortic regurg
A

CV Syphilis

  1. Obliterative endarteritis –> aortitis, aneuryms, and aortic regurg
50
Q

What is the definitive method for dx Syphilis
(can directly visual spriochete)

  • used in pts w/ chancre or condylomata lata (primary/secondary)
A

definitive method for dx Syphilis = dark field examination (microscopy –> directly visual spriochete)

51
Q

2 Screening tests for syphilis

- test for nontreponemal Abs

A

Screening tests for syphilis (test for nontreponemal Abs)

  1. RPR
  2. VDRL
52
Q

What is the name of the 2 confirmation tests used for syphilis when a screening test is (+)

A

FTA-ABS and TPPA

- Confirmation tests used for syphilis when a screening test is (+)

53
Q

What 2 tests must be performed to dx Neurosyphilis

A

Dx Neurosyphilis –> LP + VDRL

54
Q

Tx of Syphilis

  1. what is the DoC (include dose, route) for primary, secondary or early latent syphilis
  2. what changes from #1 if late latent syphilis
  3. what is the only way to tx neurosyphilis
A

Tx of Syphilis

  1. DoC = IM PCN G 2.4 million units x 1
  2. Late latent –> IM PCN G 2.4 million units for 1x/wk for 3 weeks
  3. Tx neurosyphilis –> MUST do IV PCN G
55
Q

What if pt has allergy to PCN but has Neurosyphilis

A

pt has allergy to PCN but has Neurosyphilis

  • desensitize pt –> IV PCN G
56
Q

Pt w/ syphilis treated w/PCN and few hours later pt developed fever, chills, HA, myalgia, malaise, pharyngitis and a rash

Name for this transient, inflam rxn?

A

Jarisch-Herxheimer Rxn

57
Q

What types of HPV cause external genital warts (condyloma acuminata) characterized by raised papillomatous or spiked surface

A

HPV types 6, 11 –> external genital warts (condyloma acuminata) characterized by raised papillomatous or spiked surface

58
Q

What does HPV types 16, 18, 31, 33, 45 cause

A

HPV types 16, 18, 31, 33, 35 –> flat warts, cervical CA

59
Q

The following are tx options for what?

  • cryotherapy
  • laser ablation
  • topical podophyllin
  • Imiquimod cream
  • 5-FU
A
  • cryotherapy
  • laser ablation
  • topical podophyllin
  • Imiquimod cream
  • 5-FU

tx options for HPV

60
Q

Vaccine for HPV

  1. name of it
  2. how many types does it cover
  3. Age range for administration
A

Vaccine for HPV

  1. Gardasil vaccine
  2. covers 9 types of HPV
  3. Age range for admin= BOYS + girls age 9 -26

Women's Health EOR (7 decks)

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