Infectious Diseases

Question 1

Treatment:

Chlamydia in asymptomatic patients

Answer 1

1. Single dose of azithromycin OR
2. doxycycline x 7 days

If nucleic acid amplification screening for gonorrhea is negative there is no need for concurrent treatment.

Question 2

Why should pregnant women with asymptomatic bacteriuria be treated with antibiotics?

Answer 2

Antibiotic treatment decreases the risk of:

1. pyelonephritis
2. preterm birth
3. low birth weight
4. perinatal mortality

Question 3

What are the fist line antibiotics for bacteriuria in pregnancy?

Answer 3

Amoxicillin
Nitrofurantoin
Cephalex

Question 4

Work up:

1. painful genital ulcerations
2. lymphadenopathy

Answer 4

Evaluate patient for genital herpes caused by herpes simplex virus

Question 5

What are the complications of untreated pelvic inflammatory disease (PID)?

Answer 5

1. Tubo-ovarian abscess
2. Abscess rupture
3. Pelvic peritonitis
4. Sepsis

Question 6

When should pelvic inflammatory disease be treated as an inpatient problem?

Answer 6

When the patient is unable to take oral medications due to nausea and vomiting.

Question 7

Treatment:

Syphilis in a patient with a penicillin allergy

Answer 7

First, conduct skin testing to confirm allergy.

Next, undergo desensitization so that the medication can be taken safely.

Question 8

What is the incidence of vertical transmission of HCV infection?

Answer 8

~ 2% - 5%

Question 9

True or False

Hepatitis A and B vaccinations are contraindicated in pregnant patients with chronic Hepatitis C.

Answer 9

False, all patients with chronic Hepatitis C should be immunized against Hepatitis A and B if they are not already immune.

Question 10

What is the most common cause of mucopurulent cervicitis?

Answer 10

1. Chlamydia trachomatis

2. Neisseria gonorrhoeae is the second most common cause

Question 11

Treatment:

Cervicitis caused by Neisseria gonorrhoeae

Answer 11

3rd generation cephalosporin plus azithromycin OR doxycycline.

The second agent provides empiric coverage for cephalosporin-resistant gonococci.

Question 12

Diagnosis:

1. Thin, frothy, yellow-green discharge
2. Malodorous
3. pH >4.5

Answer 12

Trichomonas vaginitis

Question 13

Diagnosis:

1. thin, off-white discharge
2. “fishy” odor
3. pH > 4.5
4. minimal to ABSENT vaginal inflammation

Answer 13

Bacterial vaginosis

Question 14

Diagnosis:

1. “cottage cheese” discharge
2. odorless
3. pH=normal
4. significant vulvar inflammation

Answer 14

Candida vulvovaginitis

Question 15

Treatment:

Trichomonas infection

Answer 15

Oral metronidazole and abstinence from sexual activity until treatment has been completed.

Clinical manifestation: vaginal discharge, pruritus, dysuria and dyspareunia (sometimes asymptomatic)

Question 16

How has perinatal HIV transmission been reduced

Answer 16

1. maternal combination antiretroviral therapy during pregnancy AND
2. neonatal zidovudine therapy

Question 17

Treatment:

HIV diagnosis made late in pregnancy

Answer 17

1. intrapartum zidovudine

2. infant zidovudine

Question 18

Treatment:

Bacterial vaginosis

Answer 18

Metronidazole

Alternatives: Vaginal Metronidazole and Clindamycin

Question 19

What important side effect should all patients taking metronidazole be warned of?

Answer 19

Disulfiram-like reactions associated with metronidazole and alcohol usage.

Question 20

Treatment:

Pregnancy complicated by antepartum maternal HSV

Answer 20

Cesarean delivery should be performed to reduce the risk for neonatal HSV.

Question 21

Diagnosis:

1. Chorioretinitis
2. Hydrocepahlus
3. Intracranial calcifications

Answer 21

Congenital toxoplasmosis

This is the classic triad.