Infections and STDs (2)

Question 1

clinical vignette for vulvovaginitis from bacterial vaginosis

Answer 1

adherent yellowish discharge; 
pH > 5;
fishy amine odor in KOH;
clue cells; 
gram neg dominate

Question 2

clinical vignette for vulvovaginitis from Candida spp

Answer 2

vulvoaginitis, pruritis; erythema;

discharge w/ consistency of cottage cheese

Question 3

clinical vignette for vulvovaginitis from Trichomonas vaginalis

Answer 3

“Strawberry cervix”;
foamy purulent discharge;
many PMNs and motile trophozoites micro (corkscrew motility)

Question 4

Pathogenesis of vulvovaginitis from bacterial vaginosis

Answer 4

overgrowth of Gardnerella vaginalis;

anaerobes

Question 5

Pathogenesis of vulvovaginitis from candida spp

Answer 5

antibiotic use => overgrowth, immunocompromised

Question 6

Pathogenesis of vulvovaginitis from trichomonas vaginalis

Answer 6

vaginitis w/ discharge

Question 7

diagnosis of vulvovaginitis from bacterial vaginosis

Answer 7

clue cells, gram neg rods

Question 8

diagnosis of vulvovaginitis from candida spp

Answer 8

germ tube test;

gram pos yeasts in vaginal fluids

Question 9

diagnosis of vulvovaginitis from trichomonas vaginalis

Answer 9

pear-shaped trophozoites w/ corckscrew motility

Question 10

Case vignette and key clues for PID

Answer 10

adnexal tenderness, bleeding, dyspareunia;
vaginal discharge, fever;
chandelier sign
onset follows menses

Question 11

pathogenesis for PID caused by Neisseria gonorrhoeae

Answer 11

pili and IgA protease production

Question 12

pathogenesis for PID caused by chlamydia

Answer 12

intracellular in mucosal epithelia;

TYPE 4 HYPERSENSITIVITY DAMAGE

Question 13

diagnosis for PID caused by Neisseria gonorrhoeae

Answer 13

Gram neg diplococci in PMNs;

culture on Thayer Martin

Question 14

diagnosis for PID caused by Chlamydia tachomatis

Answer 14

tissue culture;

intracytoplasmic inclusion bodies in mucosal cells

Question 15

Case vignette and key clues for Condyloma acuminatum (genital warts)

Answer 15

lesions are papillary/wart-like lesions;
may be sessile or pedunculated;
koilocytotic atypica is present;
anogenital

Question 16

most common cause for condyloma acuminatum (genital warts)

Answer 16

HPV

Question 17

Pathogenesis for condyloma acuminatum (genital warts)

Answer 17

HPV proteins E6, E7 inactivate cellular antioncogene;

associated w/ cervical CA

Question 18

Diagnosis for condyloma acuminatum (genital warts)

Answer 18

dsDNA, naked, icosahedral;

intranuclear inclusion bodies

Question 19

case vignette or key clues for genital herpes

Answer 19

multiple, painful, vesicular, coalescing;

recurring

Question 20

most common cause of genital herpes

Answer 20

HSV

Question 21

pathogenesis for genital herpes

Answer 21

latent virus in sensory ganglia reactivates

Question 22

Diagnosis fo genital herpes

Answer 22

virus culture, intranuclear inclusion bodies;
syncytia (Tzanck smear)
dsDNA enveloped (nuclear), icosahedral

Question 23

case vignette and key clues for primary syphilis

Answer 23

painless chancre forms on glans penis (or vulva/cervix) and heals w/in 1-3 months

Question 24

case vignette and key clues for secondary syphilis

Answer 24

local or generalized rash lasting 1-3 months;

involves palms and soles

Question 25

case vignette and key clues for tertiary syphilis

Answer 25

affects central nervous system, hear and skin; characteristic lesion is gumma; single or multiple; most common in liver, testes, and bone

Question 26

case vignette and key clues for chancroid

Answer 26

nonindurated, painful ulcer; suppurative w/ adenopathy; slow to heal

Question 27

most common cause of syphilis

Answer 27

treponema pallidum

Question 28

most common cause of chancroid

Answer 28

haemophius ducreyi

Question 29

case vignette and key clues for lymphogranuloma venereum

Answer 29

soft, painless papule heals; lymph nodes enlarge and develop fistulas; genital elephantiasis may develop

Question 30

most common cause lymphogranoma venereum

Answer 30

chlamydia trachomatis serotypes L1-3

Question 31

Pathogenesis of primary syphilis

Answer 31

3 week incubation during which spirochetes spread throughout body

Question 32

pathogenesis of secondary syphilis

Answer 32

develops 1-2 months after primary stage

Question 33

pathogenesis of tertiary syphilis

Answer 33

develops in 1/3 of untreated patients; NEUROSYPHILIS =>including meningovascular, tabes dorsalis and general paresis; obliterative endarteritis of vasa vasorum of aorta can lead thoracic aneurysm

Question 34

pathogenesis of chancroid

Answer 34

unknown

Question 35

pathogenesis of lymphogranuloma venereum

Answer 35

obligate intracellular

Question 36

Diagnosis of primary syphilis

Answer 36

biopsy/scarping viewed w/ dark-field microscopy shows spirillar organisms

Question 37

Diagnosis of secondary syphilis

Answer 37

serology => VDRL positive (nonspecific); | FTA-Abs (specific)

Question 38

diagnosis of tertiary syphilis

Answer 38

serology=> FTA-abs; non-specific tests may be negative

Question 39

diagnosis of chancroid

Answer 39

gram neg rods; | chocolate agar => requires NAD and hemin

Question 40

diagnosis of lymphogranuloma venereum

Answer 40

cell culture; | glycogen containing inclusions