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std ob gyn > std > Flashcards

std Flashcards

1
Q

what are the 5ps when educating for stds?

A

partners, practices, prevention IUP, protection STDs, past hx STds

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2
Q

what diseases are on DDX if pt presents w genital, oral, vaginal lesions?

A

Chancroid, LGV, donovanosis, herpes, syphilis

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3
Q

what should be on your DDX if pt presents w discharge?

A

Trich, BV, candida, gonorrhea, chlamydia

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4
Q

what should be on your DDX if have constitutional sx?

A

HIV/AIDS, syphilis, herpes

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5
Q

what is the PE of cervicitis?

A

red/ friable cervix with mucopurulent discharge

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6
Q

how is the cervicitis diagnosed?

A

Gram stain >100 WBC per high power field and wet prep

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7
Q

what are the 2 cervicitis?

A

Gc and chlamydia

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8
Q

how is Chlamydia diagnosed?

A

Endocervical / vaginal swab for DNA culture; NAAT; and liquid based cytology

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9
Q

What is the 1st line tx with Chlaymdia?

A

Azithromycin 1gm PO - single dose!

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10
Q

How far back do sexual partners need to be test for Chlamydia?

A

Back 60 days need to be tested

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11
Q

What are some complications of Chlamydia and Gc?

A

PID, sequelae, infertility, ectopic

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12
Q

What are the PE findings of neisseria gonorrhoeae?

A

Friable cervix with mucopurulent discharge from rectum, pharynx, cervix, and eye

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13
Q

How is Gc diagnosed?

A

endocervical/ vaginal swab for DNA culture; NAAT; liquid based cytology

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14
Q

What is 1st line tx for cervical, rectal, or pharyngeal gc?

A

Ceftriaxone 250 mg IV PLUS Azithromycin 1 g PO - single dose

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15
Q

What is 1st line tx for conjunctiva gc?

A

Ceftriaxone 1 g IV PLUS Azithromycin 1g PO

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16
Q

How long does one need to abstain from sex after gc or Chlamydia?

A

Abstain 7 days after completion of Rx for both partner and patient.

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17
Q

Is TOC needed for gc?

A

Not needed if uncomplicated rectal or urogenital w/ 1st line tx; UNLESS persistent sx, pregnancy, or suspected reinfection

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18
Q

What is PID?

A

Upper genital tract spectrum inflammatory disorder

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19
Q

What are some causes of PID?

A

N. gon, C. trach, vaginal anaerobes, G. vag, H. influ, gram neg rods

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20
Q

What are some PE findings on PID?

A

uterine, cervical, adenexal tenderness plus 1 or more : > 101 fever, mucopurulent discharge +/ friable cervix, abundant WBC in vaginal fluid, elevated SED rate + / c reactive protein, + rapid test for gc or chlamydia

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21
Q

How is PID diagnosed?

A

clinic, TVUS and laproscopy PRN

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22
Q

Can tx of PID reverse damage?

A

No, only prevent future damage.

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23
Q

What is FIRST LINE for OUTPATIENT tx for PID?

A

Ceftriazone IM PLUS doxycycline , +/- metronidazole bid

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24
Q

What are C/I for outpt PID tx?

A

Vomit, febrile, pregnant, septic, surgical abdomen not present.

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25
Q

What is the FIRST LINE tx for IN PATIENT PID?

A

IV Cephalosporin + IV doxycycline both q 12 hours

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26
Q

When would inpatient tx for PID begin?

A
  1. Failure to respond to outpt. tx in 24-72 hours
  2. Do not tolerate out pt meds
  3. Suspect tubal-ovarian abscess
  4. Pregnancy
  5. Unreliable patient
27
Q

What are the oncogenic high risk HPV strains? Low risk?

A

16 and 18

6 and 11

28
Q

How can the oncogenic HPVs be prevented?

A

Quadrivalent vaccine - 16,18,11 ,6
Bivalent - 16, 18
Nonavalent - the rest

29
Q

How is HPV transmitted

A
  1. Genital skin to skin contact
  2. Oral Genital skin to oral skin contact
  3. Anal sex
30
Q

What will be visible on the PE if pt is HPV positive??

A

Condyloma acuminata

31
Q

Which HPV types are anogential warts related to?

A

90% 6,11

32
Q

How is it diagnosed (anogen warts)?

A
  1. Visual of warts

2. HPV test with cervical cytology or colposcopy

33
Q

Treatment of macroscopic warts?

A

1st line: imiquimod, wash areas 6-10 hours post application

2. 1st line HCP - cryotherapy w/ liquid nitrogen r cryoprobe

34
Q

What are the side effects of imiquimod?

A

Local erythema, erosions, irritation, induration

35
Q

What are the side effects of cryotherapy?

A

Pain, blistering, necrosis

36
Q

How does HSV 1 manifest?

A

oral cold sores

37
Q

What will a first episode of Herpes present as?

A

Constitutional + adenopathy + lesion or lesions

Recurrent; prodrome + lesions

38
Q

How is Herpes diagnosed?

A

Cell culture and PCR

39
Q

What is being looked at in serology of Herpes?

A

HSV glycoproteins - G1 AND G2 , + results indicate anogenital infection

40
Q

What is FIRST LINE tx for Herpes?

A

ANTIVIRALS

41
Q

What is initial first line tx for Herpes?

A

antiviral - acylovir TID 7-10 x day

42
Q

What is the tx for established or recurrent Herpes?

A

Acyclovir TID, and acyclovir BID

43
Q

What is the tx for partner in Herpes?

A

Valacyclovir

44
Q

What is neurosyphilis?

A

Invasion of CNS by T. pallidum

45
Q

What are the early changes in neurosyphilis?

A

CN issues, meningitis, CVA, altered MS, eye/ear issues

46
Q

What is the primary stage of syphilis?

A

Chancre : 10-60 days post infected.
Painless punched out ulcer
Resolves on own 3-6 weeks
+/- regional adenopathy

47
Q

When does the secondary stage of syphilis start ? When does it resolve?

A

4-8 weeks post chancre

On own in 3-12 weeks

48
Q

What are the sx of secondary syphilis?

A

Great imitator - generalized non-pruritic maculopapular rash (palms and soles) , fever, HA , malaise sore throat, condyloma lata : moist flat and grey

49
Q

When is the tertiary stage of syphilis?

A

10 -30 years post infection

50
Q

What are the PE findings in the tertiary stage of syphilis?

A
  1. Gumma - necrotic/ nodular granulomatous lesion
    cutaneous - arciform, erythematous, eroded plaques with central scarring or cardiac
    CNS changes - late stage neurosyphilis
51
Q

What are the signs and sx of latent syphilis?

A

None

52
Q

What is the difference between early and late latent syphilis?

A

Acquired infection within preceding year vs. unknown duration or > 1 year

53
Q

How is syphilis diagnosed?

A

Dark field- definitive microscopy –> Serum, chancre, tissue, CSF

serology- non-treponemal and trep

54
Q

What is non-trep?

A

VDRL - venereal dz research lab

RPR - rapid plasma reagin

55
Q

What is the trep test?

A

TP-PA = t. pallidum passice particle agglutination assay

FTA- ABS = fluorescent trep antibody absorbed

56
Q

Qualified vs. Quantified serology results for syph?

A

Quant - 1:4, 1:8, 1:16, etc

Qual - FTA or TP-PA infection is reactive

57
Q

What is FIRST LINE tx for syphilis?

A

Benzathine PCN G IM

58
Q

How many doses of PCN do syphs pt need for primary, secondary, and early latent?

A

SINGLE DOSE of Benzanthine PCN G IM

59
Q

How many doses of PCN do syph pt need for late latent or unknown duration?

A

Weekly x 3 weeks of Benzanthine PCN G IM

60
Q

When do syph pts need to have clinical follow up?

A

6 and 12 months minimum

61
Q

What is Jarisch-Herxheimer rxn?

A

NOT a PCN rxn, Happens when all the organisms die off–> HA , fever within 24 hours of infection

62
Q

What is HIV/AIDS?

A

RNA retrovirus

63
Q

How is HIV/ AIDS diagnosed?

A

Rapid tests: prelim diagnosis w/in 30 minutes, if + get confirmed test

  • Serology : Antibody differentiation HIV 1 & HIV 2; HIV antigens, RNA assay
  • Serology : Combination HIV-1/HIV-2 antigen-antibody immunoassay & if positive: antibody differentiation HIV 1 & HIV 2

std ob gyn (1 decks)

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