Micro Images Flashcards
A patient complaining of discharge has this appearance on pelvic exam. How do you treat?
Metronidazole for pt AND PARTNER
(Frothy yellow discharge = trich = protozoa = metronidazole)
Tx?
Cephalosporin + azithro or doxy to cover Chlamydia
(Ox + = GC)
List at least two tests you would run on a patient with this finding.
US/CT/MRI looking for aortic aneurysm
Neurological tests
(This is a gumma of tertiary syphilis for which aortic aneurysms and dementia are common manifestations; serological testing is not very useful in this late stage)
Complication of this condition?
Respiratory distress, causing a 3% mortality rate per year in patients with infantile laryngeal papillomas due to HPV
Causative agent?
Chlamydia trachomatis L1-L3
(LGV)
Pt presents with headache and fever. Culture of CSF reveals this finding. Dx?
HSV meningitis
(Cytopathic effect = HSV; presentation + ability to culture from CSF = meningitis; CSF culture usually negative if HSV encephalitis)
Cytology of this lesion would reveal:
Multinucleated giant cells with inclusions
(Tzank cells; multiple vesicles on a red base = HSV)
“Ouch, it hurts”.
Dx?
Chancroid
(H. ducreyi)
This finding is unlikely in which stage of the disease caused by this organism?
Tertiary syphilis
(Dark field microscopy = T. pallidum; few spirochetes can be detected in lesions of tertiary syphilis)
“It burns when I urinate.” Dx?
Ct urethritis
(Milky D/C + dysuria = Ct)
A patient complaining of discharge has this finding on pelvic exam. What is the most appropriate diagnostic test?
Wet mount to look for trich
(Colpitis macularis = “strawberry cervix”; think trich!!)
Which stage of life cycle is the organism in this image in?
Latency
(Koilocytes = HPV infected epithelial cells, which are non-permissive cells where HPV lies latent)
How would you make a definitive diagnosis of the suspected organism?
KOH prep
(Vulvovaginal Candidiasis = budding yeast causing white discharge + diaper-rash appearance)
What caused this?
Congenital HSV
(This is eczema herpeticum)
What physical exam finding is unique among STDs to this disease?
Vulvar fissuring
(Caused by edematous response to Candida)
Microscopic examination of this patient’s discharge would likely reveal:
Clue cells
Gram - rods (Gardnerella)
(White, adherent discharge coating the cervix = BV)
Which cell type causes the lesion found here?
Keratinocytes
(HPV replicates in keratinocytes = permissive cells; latent in germinal cells = non-permissive cells)
What would the causative agent of these lesions look like on gram stain?
Wouldn’t see it on gram stain
(Keratitis [inflammation of cornea] caused by congenital syphilis or HSV 1; T. pallidum too thin for gram stain = must use dark field microscopy; obviously HSV doesn’t gram stain)
Dx?
Hutchison teeth due to congenital syphilis
Your gynecology attending calls you into a room during a colposcopy to ask what you think of this finding. You say….
When treated with acetic acid and viewed with a colposcope, dysplastic cells become white, so this is likely cervical dysplasia, 90% of which is caused by HPV!
A patient complains of a rash on his back and arms. PMH is non-contributory except he mentions he had a small “sore” on his penis a few months ago that didn’t bother him and went away fairly quickly. You decide to biopsy one of the lesions on his back to confirm your suspicion. What do you expect to see on gram stain?
Nothing!
(Syphilis does not gram stain; instead you would do dark field microscopy like the image)
How would you treat this?
Removal
Dx?
Chlamydia trachomatis
(Cytoplasmic inclusion bodies [vacuoles containing bugs] = Ct)
This is a possible complication of which STD? How would the patient present?
Chlamydial cervicitis/urethritis (or LGV?)
Repetitive staccato cough, peripheral eosinophilia, no fever or wheezing
(Infantile pneumonia; notice bilateral infiltrates + hyperinflation)
A female patient presents with severe pain and deformity of her hands. PMH is insignificant except a distant GC infection that was successfully treated. Xray reveals this finding. What is your diagnosis?
Reiter’s syndrome
(Aseptic arthritis that can follow Ct, GC, or bacterial enterocolitis infections)
Dx?
Gingivostomatitis due to HSV 1
Dx?
Verruca plana/HPV
This finding is a common complication of:
Tertiary syphilis
(Aortic aneurysm of ascending arch)
Dx?
Congenital syphilis
(Saber shins)
A patient present with this finding and insists that it’s nonpainful. How would you definitely diagnose it and what would be your subsequent treatment?
RPR/VDRL, FTA-Abs, dark field microscopy
PCN
(Nonpainful genital ulcer = syphilis until proven otherwise)
Dx?
HSV encephalitis
(Usually due to HSV 1; white areas = inflammed)
The pH of this discharge would be:
> 4.5
(Colpitis macularis [strawberry cervix] + frothy yellow discharge = trich]
Tx?
PCN
(Moth-eaten hair = secondary syphilis)
How would you treat a patient with this finding on cytology?
Acyclovir or similar
(Tzank smear - multinucleated giant cells with inclusions = HSV)
“It burns when I urinate.” Dx?
Gonococcal urethritis
(Purulent D/C + dysuria = GC)
PE finding?
Fish-smell discharge with KOH
(Clue cells = epithelial cells with adherent Gardnerella = bacterial vaginosis)
DDx?
GC
Chlamydia
(Ophthalmia neonatorum)
What do you suspect is “tree man”’s condition?
Epidermodysplasia verruciformis
(Genetic defect in cellular immunity leading to multiple warts on face, trunk, and limbs beginning in childhood)
Presentation?
White, clumpy discharge
Vulvar itching
Vulvar erythema, edema, fissuring
(Budding yeasts = Candida)
Your patient’s chart states he is in for an “ulcer” in his mouth. His vitals are 130/80, 38.5, 16, 82. When you go to shake his hand upon entering the room, you notice this…. What is the next step in management?
RPR or VDRL serological testing
(Mucosal ulcer + fever + rash on hands indicates secondary syphilis; sensitive non-treponemal tests are performed initially then confirmed with more specific but expensive treponemal tests like FTA-abs tests)
Inhibiting the process below would be an effective means of treatment for which of the sexually transmitted organisms we discussed?
GC, syphilis, H. ducreyi, Gardnerella
(This is the MOA of beta-lactams; Ct = IC; Ureaplasma = no cell wall; rest are fungi or protozoa; remember Gardnerella is actually treated with metronidazole)
Causative agent?
HSV 1
(Vesicles on erythematous base on finger = herpetic whitlow = HSV 1)
