Infectious Diseases (STIs and UTIs)

Question 1

How do you differentiate urethritis from cystitis?

Answer 1

Cystitis does not give urethral discharge

Question 2

What is the best initial test for urethritis?

Answer 2

Urethral swab for gram stain

Question 3

What is suspected in the presence of intracellular gram-negative diplococci? What is the next step?

Answer 3

Neisseria gonorrhoeae; initiate treatment

Question 4

What is the most accurate test for urethritis? (3 options)

Answer 4

Urethral culture, DNA probe, or nucleic acid amplification test (NAAT)

Question 5

What are other common causes of urethritis besides N. gonorrhoeae and Chlamydia trachomatis? (2)

Answer 5

Mycoplasma genitalium and Ureaplasma

Question 6

How do you treat urethritis when the organism is unknown?

Answer 6

Use a combination of one drug for gonorrhea and one for chlamydia

Question 7

How does cervicitis present?

Answer 7

Cervical discharge and an inflamed “strawberry” cervix

Question 8

How is cervicitis diagnosed?

Answer 8

Self-administered swab for nucleic acid amplification

Question 9

How is cervicitis treated?

Answer 9

Single dose of ceftriaxone and azithromycin

Question 10

How does PID present? (5)

Answer 10

Lower abdominal tenderness
Lower abdominal pain
Fever
Cervical motion tenderness
Leukocytosis

Question 11

When symptoms of PID are present, what is most appropriate next step in management?

Answer 11

Exclude pregnancy

Question 12

What is the most accurate test for PID?

Answer 12

laparoscopy

Question 13

How is PID treated inpatient vs. outpatient?

Answer 13

Inpatient: Cefoxitin or cefotetan combined with doxycycline
Outpatient: Ceftriaxone and doxycycline

Question 14

How is PID treated inpatient vs. outpatient in patients with anaphylaxis to penicillin?

Answer 14

Inpatient: Clindamycin, gentamicin, and doxycycline
Outpatient: Levofloxacin and metronidazole

Question 15

Genital ulcers that are painful are most likely…

Genital ulcers that are painless are most likely…

Answer 15

Painful: Chancroid
Painless: Syphilis

Question 16

Genital ulcers with tender lymph nodes and suppurating are most likely…
Genital ulcers that are painful and have vesicles prior to the ulcer are most likely…

Answer 16

Tender lymph nodes: Lymphogranuloma venerum

Vesicles prior to the ulcer: Herpes symplex

Question 17

What are the diagnostic tests for Syphilis?

Answer 17

Dark field microscopy
VDRL or RPR
FTA or MHA-TP

Question 18

What are the diagnostic tests for Chancroid (Haemophilus ducreyi)?

Answer 18

Stain and culture on specialized media

Question 19

What are the diagnostic tests for Lymphogranuloma venerum?

Answer 19

Complement fixation titers in blood

Nucleic acid amplification testing on swab

Question 20

What are the diagnostic tests for herpes simplex?

Answer 20

Tzanck prep is the best initial test

Viral culture is the most accurate test

Question 21

How do you treat syphilis?

Answer 21

Single dose of intramuscular benzathine penicillin (Doxy if patient is penicillin allergic)

Question 22

How do you treat chancroid?

Answer 22

Azithromycin (single dose)

Question 23

How do you treat Lymphogranuloma venereum?

Answer 23

Doxycycline

Question 24

How do you treat herpes simplex? (3 choices)

Answer 24

Oral acyclovir, valacyclovir, or famciclovir (Foscarnet for acyclovir-resistant herpes)

Question 25

How does primary syphilis present?

Answer 25

Painless genital ulcer with heaped-up indurated edges

Painless adenopathy

Question 26

How does secondary syphilis present?

Answer 26

Rash on palms and soles
Alopecia areata
Mucous patches
Condylomata lata

Question 27

How does tertiary syphilis present?

Answer 27

Neurosyphilis: Meningovascular, Tabes dorsalis, General Paresis, Argyll Robertson pupils
Aortitis: regurgitation, aneurysm
Gummas: Skin and bone lesions

Question 28

What does Argyll Robertson pupil mean?

Answer 28

Reacts to accommodation but not light