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Obstetrics and Gynecology > Infectious > Flashcards

Infectious Flashcards

1
Q

Common in cervix, vagina and vulva and penis

3-7 days after transmission

Red papules
Vesicles
Ulcers

Fever
Malaise
tender LN

A

Herpes simplex

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2
Q

HSV1

A

Oropharyngeal

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3
Q

HSV2

A

Genital herpes

Sexually transmitted

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4
Q

Lesions heal in 1-3 weeks and

HSV2 migrates to what nerve ganglia

A

Dorsal root ganglia

Thoracolumbosacral

Latent infection

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5
Q

Transmission phase of HSV

A

Active phase

Latent phase

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6
Q

Contraceptive that offers limited protection from HSV

Risk of transmission to neonate during birth

A

Condoms

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7
Q

HSV Dx

A

Viral culture

Anti-HSV Ab (indicative of recurrent or latent infection)

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8
Q

Papsmear HSV

A

3M (Margination, Molding and Multinucleation)

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9
Q

HSV DOC

A

Acyclovir 400mg - first episode, shortens length of initial and recurrent symptomatic phase

Famcyclovir 250 mg

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10
Q

Congenital herpes in neonate

A

Blisters
Jaundice
Syphilis

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11
Q

HSV cell

A

Cowdry Type A

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12
Q

Poxvirus infection skin and mucous membrane

2-12 year old via direct contact or shared articles (towels)

Incubation: 6 weeks

Increased in HIV

A

Molluscum contagiosum

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13
Q

Pearly, dome-shaped umbilicated papules with dimpled center and central keratin plugs= waxy core

Contains intracytoplasmic viral inclusions

MCV1-4

Most prevalent: MCV1
Sexually transmitted: MCV2

A

Molluscum contagiosum

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14
Q

Molluscum contagiosum cell

A

Henderson-Patterson body

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15
Q

Pox virus cell

intracytoplasmic inclusion

A

Guarneri bodies

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16
Q

Most common cause of vaginal yeast infection

Cottage cheese
Curd-like, milk-like vaginal discharge

Yeasts part of normal flora = disturbance in microbial ecosystem = symptomatic infection

A

Candida albicans

other
Candida glabrata
Candida tropicalis

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17
Q

Candida risk factors

A

DM
antibiotics
Pregnancy
Conditions resulting in compromised cell-mediated immunity

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18
Q 
Cheese vaginal discharge
Swelling and curd-like cottage 
Germ tube test
Vulvovaginal pruritus
Erythema
A

Candida

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19
Q

Discharge: watery to homogenously thick

Pseudospores or filamentous fungal hyphae in wet KOH mounts of the discharge or on pap smear

Not an STD

A

Candida

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20
Q

Candida Tx

A

Fluconazole 150mg

Nystatin

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21
Q

Sexually transmitted

Large, flagellated ovoid protozoan, seen in wet mounts of vaginal discharge or Pap smear of infected patients

Develops in 4 days - 4 weeks

Frothy vaginal discharge, pruritus vulvae

A

Trichomonas vaginalis

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22
Q

Yellow, frothy, profuse vaginal discharge, vulvovaginal discomfort, dysuria, dyspareunia

Strawberry cervix

A

Trichomonas

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23
Q

Trichomonas Tx

A

Metronidazole

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24
Q

Gram neg cocobacillus which causes bacterial vaginosis (vaginitis)

Thin, malodorous (fishy) vaginal discharge

Pap smear: squamous cells covered by a shaggy coat of cocobacilli (clue cell)

A

Gardnerella vaginalis

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25
Q

Whiff test positive
Addition of KOH: fishy amine like odor

Amsel criteria:
3/5

pH >4.5
clue cell >20
+ whiff test
Homogenous discharge

Treatment?

A

Gardnerella vaginalis

Metronidazole

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26
Q

Amsel Criteria

3/4

A

A thin, white homogenous discharge

> 20% Presence of clue cells in microscopic exam

pH >4.5

Fish odor to vaginal discharge before or after addition of 10% KOH (whiff test)

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27
Q

Ascending infection that begins in the vulva or vagina spreads upward to involve most of the structures in the female genital system

Pelvic pain, adnexal tenderness, fever, and vaginal discharge

A

Pelvic inflammatory disease

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28
Q

Two most common causes of PID

A

Gonococcus
Chlamydia

May be polymicrobial

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29
Q

Endocervical mucosa
Vestibular glands initially involved

Spread up to FT, tuboovarian regions

Marked acute inflammation largely confined to the superficial mucosa

Acute suppurative salpingitis, salpingoophoritis

Tubo-ovarian abscess or pyosalpinx

A

PID

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30
Q

PID Sequelae

A

Chronic follicular salpingitis
Hydrosalpinx (dilated, fluid filled)
Scarring tube (impenetrable to oocyte leading to infertility or ectopic pregnancy)

Hydrosalpinx -> infertility due to lack of flexible finbriae

Spreads to abdomen and lead to bacteremia

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31
Q

PID Gold standard for diagnosis

A

Laparoscopy

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32
Q

Violin string adhesions on Laparoscopy

Intraabdominal dissemination of PID

Fibrinous exudate on peritoneal surface
Perihepatitis
R upper quadrant pain

A

Fitz Hugh Curtis syndrome

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33
Q

PID Fitz Hugh Drug of Choice

A

Tetracycline

Doxycycline

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34
Q

Mucoid, clear, transluscent liquid

Lined by transitional epithelium or squamous low cuboidal mucinous epithelium

A

Bartholin cyst

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35
Q

Bartholin cyst tx

A

Marsupialization

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36
Q

Lichen sclerosus

A

Leukoplakia

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37
Q

Smooth, white plaques macules resembling porcelain or parchment

Marked thinning of epidermis, degeneration of basal cells, hyperkerarosis, bandlike lymphocytic infiltrates in the dermis

Common in postmenopausal

Pathogenesis: Activated T cells

Not premalignant but high chance of SCCA

A

Leukoplakia

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38
Q

Hairly leukoplakia is associated in

caused by

A

Side of tongue of AIDS

EBV

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39
Q

Squamous hyperplasia

Hyperplastic dystrophy
Results from rubbing/scratching
Thickening of epidermis (acanthosis) and hyperkeratosis
No increase risk of SCCA

A

Lichen simplex chronicus

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40
Q

Milk and roses hyperkeratosis of palms and soles

A

Arsenic poisoning

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41
Q

Benign genital warts caused by low oncogenic HPV 6 and 11

Solitary or multifocal

Papillary, exophytic, tree like cores of stroma covered by thickened squamous epithelium

A

Condyloma acuminatum

HPV 6, 11

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42
Q

Verucca Plantaris

A

HPV 1,3,4

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43
Q

Cervical cancer virus

A

HPV 16,18

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44
Q

Anogenital warts 90% are caused by

A

Nononcogenic HPV 6,11

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45
Q

External anogenital wart tx

A

Imiquimod cream
Podofilox gel
Cryotherapy

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46
Q

Gram negative diploccoci
Encapsulated
Fermenta maltose and glucose

A

Neisseria meningitidis

47
Q

Gram negative diplococci
Insignificant capsule
Ferments glucose only

A

Neisserie gonorrhoeae

48
Q

Gram negative diplococci with flattened sides (kidney-shaped)
Oxidase +

49
Q

Gram negative diplococci with flattened sides (kidney-shaped)
Oxidase +

Capsulated
Vaccine
Respiratory 
Glucose fermenter
Maltose fermenter
Rare beta lactamase
A

N meningitidis

50
Q

Gram negative diplococci with flattened sides (kidney-shaped)
Oxidase +

No capsule
No vaccine
Genital entry
Glucose fermenter
Non maltose fermenter
Common betalactamase
A

N gonorrhoeae

51
Q

Urethritis
Cervicitis
PID acute
Arthritis

A

Neisseria gonorrhoaea

52
Q

Urethral/vaginal discharge
Male urethritis
Endocervicitis
Infants: opthalmia neonatorum

Burning sensation during urination with discharge

Dx: intracellular gram negative diplococci in PMN from urethral smear

A

Neisseria gonorrheae

53
Q

N gonorrheae Tx

A

Ceftriaxone

54
Q

Silver nitrate prophylaxis on eye of newborn

A

Credes prophylaxis
no longer practiced bec chamydia is more common
Can cause keratoconjunctivitis

55
Q

Prophylactic antibiotic for chlamydia opthalmia neonatorum

A

Erythromycin

Tetracycline

56
Q

Cervical motion tenderness
Salpingitis
Endometritis
Ectopic pregnancy

PID from trachomatis/N gonorrhoaea

Also in ectopic pregnancy

A

Chandelier sign

57
Q

Pain
Amenorrhea
Bleeding

A

Ectopic pregnancy

58
Q

Chlamydia

Mucopurulent cervicitis

A

Azithromycin

Doxycycline

59
Q

Gonorrhoaea

Mucopurulent cervicitis

A

Ceftriaxone

Cefixime

60
Q

Motile, corkscrew-shaped prokaryotic bacterium

Flexible, helically coiled cell wall

String of beads in dark field illumination

Darting motility, rotatory motion, flexion, back and forth squiggle

A

T pallidum

61
Q

Sexual contact with lesion or body fluids

Less commonly: transplacental

Rarely: blood transfusion, accidental inoculation or puncture, organ transplantation

Incubation period: 2-6 weeks

62
Q

Declined significantly since 2000
Increased cases of primary and secondary syphilis since 2000

MSM

Risk factor: unprotected sex, partners of infected persons

Subsaharan Africa, SEA

63
Q

Primary stage of Syphillis

A

Chancre 3-12 weeks

64
Q

Secondary stage of syphillis

A

Mucocutaneous lesions
Organ involvement
4-12 weeks

65
Q

Early latent stage of syphilis

A

1 year from contact

Relapsing in 25%

66
Q

Late latent syphilis stage

A

More than 1 year
2/3 remission
1/3 CNS, Cardio involvement

67
Q

T pallidum rapidly penetrates intact mucous membranes or abraded skin then enters the blood and lymphatics

Generation time: 30 hours

Median incubation: 21 days

Average incolum: 500-1000 ave

68
Q

Women with primary or secondary syphilis more likely to transmit to fetus

Can infect any stage of pregnancy

Incidence highest during first 4 years after acquiring the infection

Risk factors: cocaine

69
Q

Risk of fetal infection in untreated early maternal syphilis

70
Q

Adequate treatment before this week AOG prevents fetal damage

Untreated maternal infections result in fetal loss (40%)

Most infected are asymptomatic at birth

A

Before 16 weeks (4th month)

71
Q 
Snuffles
Rhinitis
Desquamation
Mucocutaneous rash 
Osteochondritis
A

Early congenital syphilis

72
Q

Most frequently observed osseohs lesion in congenital syphillis

Wrist, elbows, ankles, knees
Pseudoparalysis of parrot
Periostitis of long bones

A

Osteochondritis

73
Q

Late manifestation of congenital syphilis

Bec of chronic granulomatous inflammation of bone, teeth and CNS

74
Q

Hutchinson teeth
Interstitial keratitis
8th nerve deafness

A

Hurchinson triad

75
Q

Linear scars that extend like a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and genitalia

76
Q

Depression of the nasal root, a result of syphilitic rhinitis destroying adjacent bone and cartilage

A

Saddle nose

77
Q

Abnormal 1st lower 6 years molar

A

Mulberry molars

78
Q

Bony prominence of the forehead due to persistent recurrent periostitis

A

Olympian brow

79
Q

Unilateral or bilateral thickening of the sternoclavicular third of the clavicle

A

Clavicular or Higoumenaki sign

80
Q

Convexity along the medial border of the scapula

A

Scaphoid scapula

81
Q

Unilateral or bilateral painless joint swelling (usually involving the knees)

A

Clutton’s joint

82
Q 
Saber shin
Saddle nose
CN VIII deafness
Hutchinson teeth
Mulberry molars
A

Congenital syphillis

83
Q

Saddle nose deformity

A

Wegener granulomatosis

84
Q

Soft chancre
Pain
Painful inguinal lymphadenitis

H ducreyi

85
Q

Lues maligna
Patchy alopecia
Mucous patches

A

Secondary syphilis

86
Q

Endarteritis obliterans
Aortitis, AR, Saccular

Tree bark appearance

A

Cardiovascular syphilis

Tertiary syphilis

87
Q

Asymptomatic neurosyphilis
Lack neurologic symptoms but have CSF abnormalities

RPR titer: >1:32

A

Neurosyphillis

88
Q

5 types of syphilis

A 
Asymptomatic
Meningeal
Meningovascular
General paresis
Tabes dorsalis
89
Q

Affects dorsal columns

A

Tabes dorsalis

90
Q

Tabes dorsalis affects this part of spinal cord

A

Posterior column
Vibration and position sense
Tabetic gait (ataxia)

91
Q

The great pretender

92
Q

Great masquerader

A

PE

Pheochromocytoma

93
Q

Posterior uveitis

Panuveitis

A

Ocular syphilis

94
Q

Meningeal syphillis
Meningovascular syphilis
Parenchymatous syphilis

General paresis
Tabes dorsalis

A

Neurosyphillis

95
Q

Tabes dorsalis
Gumma
Endarteritis obliterans
Syphilitic aortitis

A

Tertiary syphilis

96
Q

Pupils do not react to light
Pupils react briskly to ACCOMODATION
duling

A

Argyll Robertson pupil

97
Q

Treatment for all stages of syphilis

A

Benzathine Pen G 2.4 M IM

98
Q

Hard painless chancre

A

Primary syphilis

99
Q

Condyloma lata

A

Secondary syphilis

100
Q

If patient is allergic to PCN but has syphilis

A

Doxycycline
Tetracycline

Neurosyphilis Ceftriaxone

101
Q

Gummas
Aortitis of vasa vasorum
Tabes dorsalis
Argyll Robertson Pupil

A

Tertiary syphilis

102
Q

Syphilis Dx

A

Dark field immunoflouresence
Treponemal test
FTA-ABS
TP-PA

VDRL
RPR

103
Q

Calcutta antigen

A

Cardiolipin

Phosphatidylglycerol

104
Q 
General malaise
Fever
Sweating
Headache
Temporary exacerbation of syphilitic lesions after initial treatmenr
A

Jarisch-Herxhimer reaction

105
Q

VDRL may turn out false positive in

detects nonspecific Ab that reacts with beef cardiolipin

A 
Syphilis
Viruses (Mononucleosis, Hepatitis)
Drugs
Rheumatic fever/Rheumatoid arthritis
Lupus&leprosy
106
Q

Standardized for use on cerebrospinal fluid and becomes positive in neurosyphilis

Reagin antibodies generally do not reach the CSF from the bloodstream but are probably formed in the central nervous system in response to syphilitic infection

107
Q

PID is associated with

A

Recent menstrual flow

108
Q

Contraceptive associated with least risk for PID

109
Q

Patient administered treatment of genital warts

A

Podafilox

Imiquimod

110
Q

Provider administered genital wart

A

Trichloroacetic acid
Podophyllin resin
Cryotherapy
Surgery

111
Q

CMV is transmitted by

A

Droplet infection
Uteroplacental
Coitus

112
Q

Mucopurulent discharge after menstruation

113
Q

Measures antibodies against T pallidum

Used to determine if a positive result from a nontreponemal test is truly positive or falsely positive

A

Treponemal antibody test

TPPA T pallidum-particle agglutination
T pallidum hemagglutination TPHA
Microhemagglutination T pallidum

114
Q

Uses indirect immunofluoresence to detect reactive antibodies

The presence of IgM FTA in the blood of newborns is a good evidence of in utero infection (congenital syphillis)

Obstetrics and Gynecology (18 decks)

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