PID and Abuse Case

Question 1

A complication of PID causes RUQ pain?

Answer 1

Fitz-Hugh-Curtis Syndrome

Question 2

What is the cause of the RUQ pain is FHCS?

Answer 2

Inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ.

Question 3

What would you see in laparoscopy or a liver biopsy in patients with FHCS?

Answer 3

Violin string like adhesions of the liver capsule

Question 4

Classic finding in PID?

Answer 4

Chandelier sign

Question 5

What two infections are most commonly associated with FHCS?

Answer 5

Gonorrhea and chlamydia.

Question 6

T/F? Chancres are typically very painful.

Answer 6

False - painless although they look painful

Question 7

A single chancre and regional adenopathy is suggestive of what type of syphilis?

Answer 7

Primary

Question 8

Preferred treatment of primary syphilis?

Answer 8

Pen G benzathine 2.4 million units IM once

Question 9

Secondary syphilis includes what symptoms?

Answer 9

Systemic illness, rash involving hands and soles, fever, malaise.

Question 10

Treatment for secondary syphilis?

Answer 10

Pen G benzathine 2.4 million units IM once

Question 11

What is latent syphilis?

Answer 11

+ treponema pallidum testing w/o symptoms.

Question 12

Difference between early and late latent syphilis?

Answer 12

Early < 1 year from initial infection

Latent >1 year from initial infection

Question 13

Treatment for early latent syphilis?

Answer 13

Pen G benzathine 2.4 million units IM once

Question 14

Tertiary syphilis presents with what symptoms?

Answer 14

Late syphilis with manifestations involving the cardiovascular system or gummatous disease (disease of skin, subq tissues, bones, or viscera)

Question 15

Treatment for tertiary syphilis and late latent syphilis?

Answer 15

Pen G benzathine 2.4 million units IM once weekly for 3 weeks.

Question 16

T/F? Neurosyphilis only occurs with late syphilis.

Answer 16

False - can occur any time during course of infection

Question 17

Early neurosyphilis includes what manifestations?

Answer 17

Asymptomatic/symptomatic meningitis, stroke, vision or hearing loss.

Question 18

Late neurosyphilis includes what manifestations?

Answer 18

Involves brain and spinal cord - dementia, paresis, tabes dorsalis.

Question 19

Treatment for neurosyphilis?

Answer 19

Aqueous pen G 3-4 million units IV every 4 hours for 10-14 days.

Question 20

Syphilis infections of the ___ or ___ should always be treated as neurosyphilis.

Answer 20

eye or ear

Question 21

What are the options for the first test you would do if you suspect syphilis?

Answer 21

VDRL ( venereal disease research lab test)
OR
RPR (rapid plasma reagin test)

Question 22

If you got a positive test, what do you do next?

Answer 22

Confirmatory treponemal test

Question 23

What are the options for confirmatory treponemal tests?

Answer 23

TP-PA
FTA-ABS
TP-EIA
CIA

Question 24

Testing for gonorrhea?

Answer 24

NAAT preferred - vaginal swab in women, urine in men.

Question 25

Tx for gonorrhea?

Answer 25

Ceftriaxone 500mg IM

Question 26

If a patient needs to be treated for gonorrhea, and chlamydia has not been ruled out, does it change your treatment?

Answer 26

Yes - treat with ceftriaxone 500mg IV + doxy 100mg BID x 7 days

Question 27

Testing for chlamydia?

Answer 27

NAAT - vaginal swab in women, urine sample for men.

Question 28

Treatment for chlamydia?

Answer 28

Two first line options, Azithromycin 1g PO OR Doxy 100mg PO BID x 7 days

Question 29

T/F? Herpes infections can cause constitutional symptoms.

Answer 29

True - but they don't always cause constitutional symptoms.

Question 30

Recurrent herpes infections present with what type of lesions?

Answer 30

Small vesicular or ulcerative lesions. Vulvar irritation or fissures possible.

Question 31

T/F? If your patient is diagnosed with herpes, it is important to tell them it is a lifelong infection.

Answer 31

True

Question 32

What test is most commonly done to test for herpes?

Answer 32

Viral culture from vesicle fluid

Question 33

What is the most sensitive and specific test for herpes?

Answer 33

PCR

Question 34

What is the gold standard for herpes testing?

Answer 34

Tzank smear

Question 35

What findings on a Tzank smear indicate herpes infection?

Answer 35

Multinucleated giant cells

Question 36

Treatment for herpes?

Answer 36

Acyclovir or valacyclovir for flares and suppression if 6+ flares per year

Question 37

Describe the discharge of BV.

Answer 37

Thin off white vaginal discharge with a fishy odor

Question 38

What criteria can you use to diagnose BV?

Answer 38

Amsel criteria

Question 39

List the Amsel criteria.

Answer 39

Homogenous thin white/grey discharge that coats vaginal wall Vaginal pH > 4.5 Positive whiff amine test with 10% KOH solution Clue cells on saline mount, at least 20% epithelial cells

Question 40

How many of the Amsel must be met to dx BV?

Answer 40

3/4

Question 41

Tx for BV?

Answer 41

Metronidazole or clindamycin

Question 42

Describe the discharge of candidiasis.

Answer 42

Cottage cheese like thick, white.

Question 43

What are some associated symptoms with the discharge in candidiasis?

Answer 43

Intense pruritis, could have excoriations with bleeding. Dysuria Dyspareunia

Question 44

What do you need to diagnose candidiasis?

Answer 44

Went mount with budding yeast and hyphae on KOH prep

Question 45

Tx for candidiasis?

Answer 45

Oral fluconazole or topical clotrimazole or miconazole.

Question 46

Why do you need to exercise caution when prescribing fluconazole?

Answer 46

A lot of DDIs

Question 47

Describe the discharge with trichomoniasis

Answer 47

Malodorous greenish-yellow thin discharge.

Question 48

Cervical appearance with trichomoniasis?

Answer 48

Strawberry cervix

Question 49

Gold standard trich testing?

Answer 49

NAAT

Question 50

Wet mount of trichomonas shows?

Answer 50

Flagellated trichomonads

Question 51

Tx for trich?

Answer 51

Metronidazole or tinidazole x 7 days