Reproductive system Flashcards

Question

Neisseria gonorrhoeae-GRAM when ?

Answer 1

Male urethra: direct specimen Gram always done they dont have GNDC in NF -report pus and GNDC intra or extracellular -indicates infection in men -confirm with culture, NAAT Cervical, rectal, throat: no direct specimen Gram done -can have other GNDC that are NF like Moraxella, Kingella and Acinetobacter

Answer 2

Media for isolation: Non-selective CHOC + a selective agar selective agar: Thayer-Martin (TM), Modified Thayer Martin (MTM), Martin Lewis (ML), New York City (NYC)

Answer 3

-Enriching ingredients like Iso-Vitalex -Blood product: e.g. lysed blood, horse blood or horse serum Antibiotics to make it selective: -Colistin: inhibits GN -Vancomycin: inhibits GP – *some GC strains are susceptible to vancomycin*. use Lincomycin -Nystatin or amphotericin B: inhibits yeast b/c women have yeast a bit as NF

Answer 4

-plate specimen to non- selective + selective agar -AHU strains of GC that need Arginine, hypoxanthine, uracil are more susceptible to vancomycin or trimethoprim (wont grow on TM but will on CHOC) -may not grow on selective media -non pathogenic Nessie can grow on GC selective media CHOC & selective agar (TM) incubate 35oC in 5% CO2 for up to 72 hrs., examine every 24 hrs.

Answer 5

N. gonorrhoeae (will grow on blood flu will NOT) -mucoid, granular , shiny, convex, clear or grey/white N. meningitidis -large, blue grey, raised, granular, shiny, convex, mucoid Staphylococcus, Candida albicans, Enterobacterales -inhibited should be No or scant growth Pseudo or ESBL may grow

Answer 6

Strict aerobe, capnophilic do oxidase first if ox neg on both = STOP TESTING > reincubate both for 72 hours Oxidase pos on both -gram from TM ONLY > GNDC> from selective media 2 ID test with 2 diff principles MALDI first, then Bacticard - PRO POS -if not enough take colonies form TM subculture to CHOC and do next day , can take from CHOC ONLY IF ORIGINAL CAME FROM SELECTIVE MEDIA NEVER "PROBABLE N GONO" B lactamase after 2 ID test > send to PHL If still negative for GC at 72 hours- report as neg for N. gonorrhoea oxidase on plate = purple then sub onto CHOC Can also Superoxol test positive with drop of h2o2 - catalase test with 30% h2o2 whereas routine is 3%. This test diff between Neis Gono and other Neis

Answer 7

type: cotton or rayon swabs in Amies or Stuarts Routine testing Gram - quantity of pus cells, if trich or yeast -Nugent scoring guide determines if vaginal flora is normal, altered or has bacterial vaginosis -GNDC is not reported from female samples Wet prep- for trich and yeast Vaginal swab cultured in -young girls, SA, GBS for pregnancy, S aureus for toxic shock

Answer 8

-roll and dab with sterile saline -coverslip then under 40x look for yeast or motile trich -can put slide in incubator for a few mins to revive motile trich Report . Trichomonas vaginalis seen or not seen 2. Yeast cells seen or not seen *Do not quantitate either organism if seen* Dont report pus or epithelial cells on wet prep only a gram

Answer 9

-NF in women if just a few -if they overgrow then its vaginitis -can overgrow if there is a decrease in NF, AB use, hormone imbalance, immune system compromised -itchy, pain with sex or peeing, thick white discharge -diagnosed with Vaginal swab WP and gram -yeast culture not done unless requested - SAB media -ID with wet prep, germ tube (Albican is pos) urea neg, chlamydo pos******CSMLS in men - source is diabetes or sex - asymp

Answer 10

Flagellate trophozoite – Amoebic parasite Transmitted sexually women -causes vaginitis -bad smelling discharge, itching , painful urination -high risk of premature labor -Diagnose with WP, Gram of vaginal swab = motile troph -tric specific media men -asymp- contributes to spread

Answer 11

-AB to suppresses bacteria/yeast -nutrients + agar to reduce oxygen, grows better ANO2 -Inoculate swab in media ASAP– Trichomonas dies quickly -Incubate in O2, 350 C for up to 5 days – check daily for motile trophs by wet prep culture is gold standard -disadvantage is that a positive takes days

Answer 12

-Specimen inoculated into broth in clear plastic pouch -Kept at O2 350 C for up to 7 days. -Media inhibits bacteria/yeast. -Can observe under microscope right through plastic pouch -Irregular shape -oval nucleus at one end -frothy/lacy cytoplasm -axostyle or flagella seen -larger than pus but smaller than skin cell

Answer 13

Molecular testing- NAAT -Nucleic Acid Hybridization , detect even dead orgs Genzyme Diagnostics' OSOM Trichomonas Rapid Test -POCT -vaginal swabs that can be done at home with 2 monoclonal AB to trich and one to a blue particle -Positive = blue +red control line

Answer 14

-Acid pH in vagina maintained by Lactobacilli -< Lactobacilli = alk pH = overgrowth of other facultative & anaerobic bacteria = BV. Organisms that indicate BV: Gardnerella vaginalis Mobiluncus spp. Other anaerobes (Prevotella spp., Bacteroides spp., etc.) -protein degradation in vagina by anaerobes = amines that smell bad -alk pH lets bacteria attach to epithelial cells = clue cells -diagnosed by score on nugent score 7-10 + clue cells -NO/RARE PUS CELLS

Answer 15

-alkaline vaginal fluid (litmus paper); pH >4.5 -watery non-inflammatory discharge Foul odor of exudate (add KOH to vaginal fluid)

Answer 16

Norm = Lactobacilli Altered - lactobacilli +gardnerella +Mobiluncus OR -little lacto + strep or gnb BV - more gardnerella than mobiluncus +maybe clue cells

Answer 17

-microscope scoring system to see if you have BV or yeast/trich -scan 10 fields under 10X for Trichomonas/Yeast -100x & quantitate pus, epithelial -quantitate any Lactobacillus, Gardnerella & or Mobiluncus that you see & give it a grade (0, 1+, 2+ etc.) -at 100X for Trichomonas or yeast look but dont quantitate -assign score as per the system to Lactobacillus, Gardnerella & Mobiluncus that you saw -Total the score & use this to determine if normal (0-3), altered (4-6) or BV (7-10) -ONLY REPORT IF CLUE CELLS ARE SEEN

Answer 18

Lactobacilli - thin long straight or slighty curved Mobiluncus - wispy thin curved GN/GP, look like seeds Gardnerella - short gram variable -clump together like clouds -smaller than Haemophilus

Answer 19

Early onset (prenatal & <7 days old) -aspiration of amniotic fluid causes pneumoniae or sepsis -high mortality Late onset >7 days - meningitis , pneumonia GBS screening - vaginal swab at 35 weeks - GBS usually in vagina or lower intestine -vaginal (only if Dr notes that pt is pregnant) or rectal swabs -NO CERVICAL SWAB -STREP B chrome agar-Incubate in O2 at 350C

Answer 20

-inoculated directly with vaginal/rectal swab or used with selective enrichment broth -Todd Hewitt - grows both BH & NH GBS at 24 hrs -Selective & Differential media -1 chromogen = turquoise/blue colour due to GBS enzyme production -2nd chromogen = non-GBS = pink colonies -Blue colonies are presumptive positive for GBS confirmed directly from plate by Pathodx. -Report and phone any amount – do not quantitate any amount is significant -Can also do D test directly from colony if pt is allergic to penicillin

Answer 21

*Most sensitive & recommended procedure* for GBS isolation - but takes longer to isolate -Selective, enrichment broth used to grow BHS (also called LIM broth) Selective with -Colistin & Nalidixic acid prevents growth of GN -Enriched with Peptones, heart infusion, yeast, dextrose + vitamins & buffers SB Enrichment (suppresses NF for short time): Inoculate vag/rec swab to THB broth and incubate 18-24hrs in O2 35C Sub broth to BA or CHROME agar, within 18-24hrs or other organisms might overgrow

Answer 22

-vag/rectal swab to this Selective, differential broth -GBS = broth goes from white to orange - no more testing -result in 16-24 hrs -NH GBS cant be seen with color change -no color change then sub culture to BA to confirm there is no GBS -use BA plate for pathodx or d test

Answer 23

-from the mother eating contaminated food - moves cell to cell -crosses placental barrier causing stillbirth Early NB <7 days -intrauterine infection or during birth -sepsis , meningitis , high mortality Late onset NB >7 days -infection after birth manifests as meningitis - lower fatality rate -if baby dies get moms blood culture or amniotic fluid -if baby alive get baby csf or blood culture

Answer 24

BA & CNA: small, round, grey, narrow zone BH (looks identical to GBS) Grows in O2 or CO2 35C Can also do a cold enrichment technique -incubate at 4C Gram Stain: Small gpb Catalase: positive BE: positive WP: tumbling motility Umbrella motility on SIM when incubated at RT only SIM motility at 35 C: non motile Susceptibility: “Normally susceptible to penicillin”

Answer 25

-presence of fecal/genital contaminants -treat like weep wound with GC infection -put on all media + THIO, TM for GC -report if GC there or not -non pathogens = Genital flora

Answer 26

Endometrial biopsy, or curetting of the placenta, products of conception, fallopian tube, ovarian aspirate taken in OR during surgery

Answer 27

-scrap the lining of the uterus -deep but can be contaminated from dr going through vagina -plated to all +thio+tm -look for GC -non pathogens = genital flora