PID

Question 1

A patient presents with sharp RUQ pain, pleuritic pain and has noticed some referred pain to her right shoulder. On palpation there is RUQ tenderness. She has a dx of PID already. What is the most likely diagnosis?

Answer 1

Fitz-Hugh Curtis Syndrome (perihepatitis)

Question 2

A hallmark sign of PID is this

Answer 2

chandelier sign

Question 3

Clue cells on wet mount indicate what?

Answer 3

BV

Question 4

Budding hyphae on on wet mount indicate what?

Answer 4

Candidia

Question 5

Trichomonads on wet mount indicate what?

Answer 5

Trichomonas

Question 6

What is a clinical manifestation of early primary syphilis? What is the treatment?

Answer 6

Single painless chancre and regional adenopathy

TX: Pen G benzathine IM once (because any time you can give a one time directly observed tx you should)

Question 7

What is a clinical manifestation of early secondary syphilis? What is the treatment?

Answer 7

Rash on the hands and the soles of the feet “money spots”

TX: Pen G benzathine IM

Question 8

What is a clinical manifestation of late tertiary syphilis? What is the treatment?

Answer 8

Affects the heart and granulomatous disease (gumma) which are these weird tumor looking things

TX: Pen G Benzathine IM

Question 9

What is a clinical manifestation of neurosyphilis? What is the treatment?

Answer 9

Meningitis, hearing loss, vision changes

TX: Aqueous Pen G IV every 3 to 4 hours for 10 to 14 days

Question 10

When a person when a patient is infected with Treponema pallidum but has no symptoms, what is this called?

Answer 10

Early latent (if within the first year of infection) or late latent (if over 1 year since infection)

Question 11

Do you make the dx of syphilis solely based on RPR?

Answer 11

No

Question 12

How do you make the dx of syphilis?

Answer 12

You do VDRL or RPR and then confirm with the confirmatory tests

Question 13

What is the preferred testing for gonorrhea?

Answer 13

NAAT

Question 14

What are some symptoms of gonorrhea?

Answer 14

Can be asymptomatic or can have mucopurulent discharge, pruritis, dysuria and uncomfortable sex

Question 15

What is the treatment for a gonorrhea infection alone?

Answer 15

Ceftriaxone 500mg IM x 1

Question 16

What is the tx for gonorrhea with concurrent chlamydia?

Answer 16

Ceftriaxone 500mg IM x 1 PLUS doxycycline 100 mg BID x 7 days

Question 17

Clamydia can cause what two complications in men?

Answer 17

epididymitis and chronic prostatitis

Question 18

In younger men, chalmydia can be caused by _______ whereas in older men, it can be caused by _____

Answer 18

chlamydia, E.coli

Question 19

What are some symptoms of chlamydia?

Answer 19

Most asymptomatic, but cervicitis, discharge, dysuria and abnormal vaginal bleeding possible.

Question 20

What is the test of choice for chlamydia?

Answer 20

NAAT (swab for women, urine for men)

Question 21

What is the tx for chlamydia?

Answer 21

Doxycycline & azithromycin both are first line

Question 22

Co-infected with gonorrhea and chlamydia what is the tx?

Answer 22

doxy and ceftriaxone

Question 23

If this is a patient’s first infection with herpes, what symptoms would they have?

Answer 23

Can be mild and asymptomatic or have a fever/constitutional

symptoms with painful genital ulcers

Question 24

If this is a patient’s recurrent infection with herpes, what symptoms would they have?

Answer 24

Usually unilateral small vesicular or ulcerative lesions. Could have vulvar irritation or fissures.

Question 25

What is the best test for herpes?

Answer 25

Viral culture with fluid from unroofed vesicle

Question 26

Is a serologic test a good test for herpes?

Answer 26

No. Because people can have HSV1 which you don’t need to tx

Question 27

This test would show multinucleated giant cells for herpes but has a low sensitivity and specificity

Answer 27

Tzanck smear

Question 28

How do you treat a flare of herpes?

Answer 28

acyclovir or valacyclovir

Question 29

How do you tx persistent herpes infection?

Answer 29

acyclovir or valacyclovir

Question 30

T/F: herpes can be cured

Answer 30

false herpes is for life

Question 31

A female patient presents with thin off-white vaginal discharge and a fishy smell that is worse with sex and menses. What is the next step? What disease is this?

Answer 31

Amsel criteria (3/4 needed):
• Homogenous thin white/gray discharge that coats vaginal walls
• Vaginal pH >4.5
• Positive whiff-amine test with 10% KOH
• Clue cells on saline mount, at least 20% epithelial cells

Question 32

Treatment for BV?

Answer 32

Metronidazole (oral or topical)

Question 33

A patient presents with cottage-cheese like white discharge and intense pruritis. She has painful urination and painful sex. What is the next step?

Answer 33

Wet mount with KOH

Question 34

What would a wet mount show in a patient with candidiasis?

Answer 34

Wet mount shows budding yeast, hyphae.

Question 35

Treatment for candidiasis?

Answer 35

oral fluconazole x 1 dose (but it interacts with a LOT of drugs)

Question 36

A patient presents with 3 days of greenish yellow thin discharge associated with burning and lower abdominal pain. You look into her vagina and notice a strawberry cervix. What is the dx?

Answer 36

Trichomoniasis

Question 37

What is important to remember when looking at a slide with trichomoniasis?

Answer 37

You can kill trich from a light so you want to immediately look at it after putting a drop on the slide

Question 38

Are medical professionals required to report all cases of domestic violence to the police?

Answer 38

No, given that the patient is >18 but not an elder

Question 39

Are medical professionals required to report cases of domestic violence such as a GSW, stab or fractures?

Answer 39

yes!