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Infectious Diseases USMLE Step 3 > Section 8: Sexually Transmiited Diseases > Flashcards

Section 8: Sexually Transmiited Diseases Flashcards

2
Q

Rx for folliculitis, furuncles, carbuncles and boils.

A

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

If large, as in boils, do I & D.

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3
Q

Best initial diagnostic test for fungal infection of the skin or nail

A
  • KOH preparation
    1. Scrape the skin or nail.
    2. Place the scraping on a slide with KOH and acid and heat it.
    3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.

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4
Q

Rx for fungal infection of the skin and nail

A

Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox

Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis)

– Terbinafine: Causes increased liver function tests

– Itraconazole

– Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.

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5
Q

Best initial test for urethritis

A

Urethral swab for Gram stain, WBC count, culture, and DNA probe

Nucleic acid amplification tests (NAATs) are highly effective as well

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.

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6
Q

Basic principle for Rx of urethritis

A

Two medications: one for gonorrhea and another for Chlamydia

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7
Q

List some gonorrhea medications

A

Ceftriaxone IM

Cefixime oral

Cefpodoxime oral

Ciprofloxacin oral (2nd line)

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8
Q

List the medications for Chlamydia urethritis

A

Azithromycin (single dose)

Doxycycline (for one week)

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9
Q

Rx for urethritis in pregnancy

A

Ceftriaxone IM and

Azithromycin

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10
Q

What predisposes a patient to recurrent infections with Neisseria?

A

Terminal complement deficiency

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11
Q

Single best test for gonorrhea and Chlamydia?

A

Nucleic acid amplification test (NAAT)

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12
Q

What blood finding is a measure of severity in PID?

A

Leukocytosis

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13
Q

Best initial test for PID

A

Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.

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14
Q

Most accurate test for PID

A

Laparoscopy

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15
Q

How to collect samples for nucleic acid amplification test

A

NAAT can be done on voided urine for men or blind vaginal swab in women.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.

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16
Q

Outpatient Rx for PID

A

Ceftriaxone (IM) and doxycycline (oral)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.

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17
Q

Inpatient Rx of PID

A

Cefoxitin (IV) and doxycycline and maybe metronidazole.

Cefotetan can be used instead of cefoxitin.

Remember, PID ends with D and its Rx always includes Doxycycline whether inpatient or outpatient. For inpatient Rx the accompanying cephalosporin is cefoxitin, which has an “X” like the one in doXicyclin. Of course cefotetan can be used in place of cefoxitin since these are the cephalosporins with anerobic effects.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.

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18
Q

List four classes of antibiotics safe in pregancy

A

Penicillins

Cephalosporins

Aztreonam

Macrolides (Azithromycin and Erythromycin)

Use the mnemonic “CAMP”

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19
Q

Presentation of epidydimo-orchitis

A

An extremely painful and tender testicle with a normal position in the scrotum.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.

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20
Q

Rx of epidydimo-orchitis

A

< 35 years of age: Ceftriaxone and doxycycline

> 35 years of age: Fluoroquinolone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.

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21
Q

Causative agent: painful genital ulcer

A

Haemophilus ducreyi

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.

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22
Q

Best initial test for chancroid

A

Swab for Gram stain (gram-negative coccobacilli) and culture (will require specialized medium: Nairobi medium or Mueller-Hinton agar).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.

23
Q

Rx for chancroid

A

Single IM shot of ceftriaxone or single oral dose of azithromycin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.

24
Q

Causative agent: Lymphogranuloma venereum (LGV)

A

Chlamydia trachomatis

25
Q

Rx of Lymphogranuloma venereum (LGV)

A

Aspirate the bubo.

Treat with:

  • Ddoxycycline
  • Azithromycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.

26
Q

Causative agent: Genital herpes

A

Herpes simplex virus type 2 (HSV2)

27
Q

When is it necessary to do the Tzanck prep test in HSV2

A

If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology,

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.

28
Q

Rx for HSV2

A

Acyclovir

Valacyclovir

Famciclovir

Rx is for 7– 10 days

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.

29
Q

Rx for acyclovir resistant herpes

30
Q

Rx for HSV2 in pregnancy

31
Q

Rx for cytomegalovirus (CMV)

A

Ganciclovir

32
Q

What is the most accurate test in primary syphilis?

A

Darkfield microscopy. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.

33
Q

Rx for primary syphylis

A

Single shot of IM penicillin

34
Q

Rx of primary syphilis in those with penicillin allergy

A

Doxycycline

35
Q

Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.

A

Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.

36
Q

Initial diagnostic test for secondary syphilis

A

RPR (Rapid Plasma Reagin)

FTA (Flourescent Treponemal Antibody)

37
Q

Rx for secondary syphilis

A

Single IM shot of penicillin

Use doxycycline for the penicillin-allergy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.

38
Q

Features of tertiary syphilis

A

Neurosyphilis: Tabes doralis, general paresis, Argyll-Robertson pupil

Gummas

** Aortitis**

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.

39
Q

Initial diagnostic test for tertiary syphilis

A

RPR and FTA

Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA).

CSF VDRL is only 50 percent sensitive.

Neurosyphilis is excluded with a negative CSF FTA.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.

40
Q

Rx for tertiary syphilis

A

IV penicillin

If allergic, desensitize

41
Q

Rx of syphilis in pregnancy

A

Desensitization

42
Q

Diagnosis: rare, beefy red genital lesion that ulcerates.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.

A

Granuloma inguinale

43
Q

What is the diagnostic testing and causative organism for Granulama inguinale

A

Biopsy or “touch prep,”

Klebsiella granulomatis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.

44
Q

Rx for Granuloma inguinale

A

Doxycycline

TMP/SMX

Azithromycin

45
Q

Compare and contrast pediculosis and scabies

A

Pediculosis Scabies

  • Larger • Small
  • In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces
  • Visible on the surface • Scrape and magnify
    • Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.

46
Q

Rx of Warts

A

Perform surgical removal if large.

Imiquimod is an immunostimulant that leads to sloughing off of the wart.

Cryotherapy, laser removal, and melting with podophyllin are other options.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.

47
Q

Rx of cystitis

A

Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is > 20 percent, then use ciprofloxacin or levofloxacin.

“Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.

48
Q

When is it right to treat asymptomatic bacteriuria

A

In pregnancy

49
Q

What are the outpatient and inpatient Rx of pyelonephritis

A

Outpatient: Ciprofloxacin

Inpatient: IV Ampicillin + Gentimicin

50
Q

Diagnoses:

  1. Dysuria + white cells in urine + suprapubic tenderness
  2. Dysuria + white cells in urine + flank pain + fever

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.

A
  1. Cystitis
  2. Pyelonephritis
51
Q

List those for whom Rx is required in asymptomatic bacteriuria

A
  • Pregnancy
  • Urologic intervention
  • Hip arthropathy
52
Q

List those who do not require Rx in asymptomatic bacteriuria

A
  • Nonpregnant premenopausal women
  • The elderly
  • DM
  • Patients with spinal cord injury
  • Patients with chronic indwelling urinary catheters

Infectious Diseases USMLE Step 3 (8 decks)

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