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obstetric - gynecol STEP 2 > infections (non pregnancy) > Flashcards

infections (non pregnancy) Flashcards

1
Q

indications for hospitalization for PID

A
  1. Pregnancy
  2. failed outpatient treatment
  3. inability to tolerate oral medications
  4. non compliant
  5. severe presentation (high fever, vomiting
  6. complications (eg. tubo-ovarian abscess, perihepatitis)
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2
Q

outpatient regimen fof PID

A
  • IM ceftriaxone + oral doxycycline
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3
Q

inpatients regimen for PID

A

IV cefoxitin or cefotetan plus oral doxycycline or parental IV clincamycin plus gentamicin

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4
Q

Septic pelvic trombophlebitis - RF

A
  1. cesarean
  2. pelvic surgery
  3. endometritis
  4. PID
  5. pregnancy
  6. Malignancy
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5
Q

Septic pelvic trombophlebitis - pathophys

A

hypercoagulability
pelvic venous dilation
vascular trauma
infection

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6
Q

Septic pelvic trombophlebitis - presentation

A
  1. fever unresponsive to antibiotics
  2. no localised signs/symptoms
  3. negative infectious evaluation
  4. diagnosis of exclusion
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7
Q

Septic pelvic trombophlebitis - treatment

A

anticoagulation

broad spectrum antibiotics

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8
Q

Gonococcal pharyngitis

A

fever, and lower abdominal pain (associated with PID)

–> non tender cervical lymphadenopathy

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9
Q

infectious genital ulcer - ddx

A

painful: HSV, H. ducreyi (chancroid)
painless: syphylis, Chlamydia trachomatis L1-L3)

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10
Q

how to confirm genital HSV

A

PCR

2nd line: culture or Tzank smear

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11
Q

genital hsv vs H. ducrey on presentation

A

HSV –> small vesicles or ulcers on erythematous base, Mild lymphadenopathy
ducrey –> larger, deep ulcers with gray/yellow exudare, well demarcated, SEVERE lymphadenopathy that may suppurate

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12
Q

HPV infection - vaccination?

A

yes –> do the vaccine

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13
Q

non pregant women with syphilis and allergy to penicillin

A

doxicycline

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14
Q

staph toxic shock syndrome - risks

A

tampon use
nasal packing
surgical/postpartum wound infection

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15
Q

staph toxic shock syndrome - mechanism

A

S. aureus –> exotoxin (superantigen)

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16
Q

staph toxic shock syndrome - clinical features

A
  • fever (39 or more)
  • HYPOTENSION
  • DIffuse macular rash (palms + soles)
  • desquamation 1-3 wks after disease onset
  • vomiting diarrhea
  • altered mental status (no focal signs)
17
Q

staph toxic shock syndrome - treatment

A

supportive therapy
removal of foreign body
antibiotic (eg. clindamycin + vanco

18
Q

chlamydia and gonorr - treatment

A

empiric: azytthro + ceftriaxone
confirmed chlamy only: azythromycin
confirmed gonorh only: azith + ceftriaxone (due to increasing resistance to cephalosp)

19
Q

condylomata acuminata - etiology / prevention

A

HPV 6, 11

vaccination, barrier contraception

20
Q

condylomata acuminata - clinical features

A

multiple pink or skin-colored lesions

lesions ranigng from smooth, flattened papules to exophytic/cauliflower like growths

21
Q

condylomata acuminata - treatment

A

chemical: podophyllin resin, trichloroacetic acid
immunologic: imiquimod
surgical: cryotherapy, laser, excision

22
Q

condylomata lata - how to differentiate them from acuminata

A

lata are flat, velvety lesions –> broader base and flatter surface and are lobulated or plaque-like

23
Q

characteristics of ulcerative STD - diseases and agents

A

Chancroid - h. ducreyi
Genital herpes - HSV 1 + 2
Granuloma inguinale (donovanosis) - Klebsiella granulomatis
syphilis - Treponema pallidume
Lymphogranuloma venereum - C. trachomatis

24
Q

syphilis - features of primary lesion

A

single, indurated welll circumscribed ulcer

clean base

25
Q

Lymphogranuloma venereum - features of primary lesion

A

small shallow ulcers

large painful coalsesced inguinal lumph nodes (buboes)

26
Q

Granuloma inguinale - features of primary lesion

A

extensive + progressive ulcerative lesions without lymphadenopathy
base may have granulation like tissue
gram negative intracytoplasmic cysts (donovan bodies)

27
Q

chancroid - features of primary lesion

A

multiple + deep ulcers
base may have gray to yellow exudate
organism often clump in long parallel strands

28
Q

genital herpes - features of primary lesion

A

multiple small grouped ulcers
shallow with erythematous base
sms often clumg in long parallel stands

29
Q

syphilis - treponemal vs nontreponemal

A
  • nontreponemal (RPR, VDRL: anti-cardiolipine, quantitive, decreased titers confirm treatment, possbile FN in early infection
  • Treponemal (FTA-ABS): anti-treponemal, qualitive, greater sensitivity in early, positive after treatment
30
Q

recommendations for chlamydia and neisseria screening fo women

A

anual in all sexually active women age under 25 and 25 or older with risk factors

31
Q

a risk factor for bacterial vaginosis

A

douching

32
Q

tubo-varian abscess (complication of PID) - presentation

A

fever, abd pain, COMPLEX MULTILOCULATED ADXENAL MASS WITH THICK WALLS AND INTERNAL DEBRIS ON u/s, ELEVATED LEUKOCYTOES, ELEVATED ca125 + crp

obstetric - gynecol STEP 2 (22 decks)

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