Micro - urogenital

Question 1

PID

Answer 1

ascending infection of upper reproductive tract

endometritis
salpingitis
oophoritis
hydrosalpinx
tuboovarian abscess

Liver capsule - Fitz-Hugh-Curtis Sn
-violin string adhesions

Cause:
N. gonorroheae
C. trachomatis
Polymicrobia

Sx: pelvic/lower abd pain
Mucopurulent cervical discharge
cervical motion tenderness - Chandelier sign

Tx: broad spectrum abx

Complications:
infertility
chronic pelvic pain
ectopic pregnancy

Question 2

Discharge, pH, Wet mount and tx for Gardnerella

Answer 2

Discharge: thin gray-white, goats walls; fishy odor

Vaginal pH: >4.5

Wet mount: clue cells; KOH+ whiff test, fishy

Tx: metronidazole, clindamycin

Question 3

Discharge, pH, Wet mount and tx for Candida spp

Answer 3

Discharge: thick, white cottage cheese like

Vaginal pH: 4-4.5

Wet mount: budding yeast, pseudohypha

Tx: -azoles, nystatin cream

Question 4

Discharge, pH, Wet mount and tx for Trichomonas vaginalis

Answer 4

Discharge: frothy, yellow-green, fishy odor

Vaginal pH: >4.5

Wet mount: pair shaped protozo w/ flagella; trichomonads

Tx: metronidazol

Question 5

Condylomata acuminata

Answer 5

HPV 6, 11

Koilocytosis - perinuclear cytoplasmic clearing

Question 6

Neisseria gonorrhea

Answer 6

females: cervicitis, urethritis, asx
PID

Males: urethritis –> dysuria, mucopurulent discharge
epididymitis

disseminated infection
gonococal arthritis

Question 7

Chlamydia serotypes D-K

Answer 7

usually asx

Females: cervicitis, urethritis - dysuria; PID
Males: urethritis, epididymitis, prostatitis

Conjunctivitis - direct innoculation w/ genital secretion

Reactive arthritis - MC cause

Question 8

Lymphogranuloma venerum

Answer 8

Chlamydia Serotype L1-L3

painless genital ulcer
extends into LN –> painful inguinal LAD
Bubo can rupture

Question 9

HSV2

Answer 9

genital herpes

multiple vesicles on erythematous base
painful
roofs come off vesicles –> erode to shallow ulcer

Primary systemic infection: fever, HA, malaise, myalgias

recurrent outbreaks less severe

Question 10

Haemophilus ducreyi

Answer 10

Chancroid

Painful genital ulcer
painful inguinal LAD

multiple
distinct borders
purulent exudate

gram - rod: “school of fish” appearance

Question 11

T. pallidium

Answer 11

Syphilis
primary: painless genital ulcer - edges raised, indurated

secondary: systemic: fever, HA, myalse, general LAD
- rash: palms, soles - erythematous macules –> papules
- condyloma lata - wart like genital lesions - flat, smooth, moist

tertiary: neurosyphilis
- tabes dorsalis
- argyll robinson pupil
- dementia

CV syphilis: syphilic aortitis
Gummatous syphilis: granulomatous lesions on skin

Question 12

UTIs general

Answer 12

fecal flora in urinary tract

Cystitis - lower
Pyelonephritis - ureter and kidney

Females MC
vesiculouretral reflux
urinary obstruction: BPH, tumors, stones
Catheterization
Bladder dysfunction and urinary stasis
-DM, neurogenic bladder
-spinal cord injury
pregnancy
immunosuppression

Question 13

Cystitis sx and UA

Answer 13

dysuria
frequency
urgency
suprapubic pain
hematuria

UA:
bacteria
WBCs
\+leukocyte esterase
\+nitrite -enterobacteria (Ecoli)
RBCs
NO WBC casts

Question 14

Pyelonephritis sx and UA

Answer 14

S/S of cystitis
fever/chills
N/V
flank pain
CVA tenderness

UA same as cystis + WBC casts

Question 15

Bacteria causing UTIs

Answer 15

E coli

Proteus mirabilis (gram - swarming motility, urease +, raises pH –> struvite kidney stones –> staghorn calculus)

Klebsiella pneumoniae (cause struvite kidney stones)

Enterobacter

Gram +: S. saphrophyticus - 2 MC in females

Less common:- usually hospitalized patients
Serratia
Pseudomonas