STD/kidney/endocarditis/HIV

Question 1

Best initial test for urethritis, most accurate?

Answer 1

Urethral swab
Urethral culture/NAAT
Tx is ceftriaxone/azithromycin

Question 2

Cervicitis

Answer 2

Dx’d with NAAT

TX’d with ceftriaxone/azithromycin

Question 3

What is the first step in a woman with cervical motion tenderness, fever, leukocytosis, and lower abdominal pain?

Answer 3

Rule out pregnancy. This presentation is pelvic inflammatory disease, but you must rule out ectopic pregnancy

Question 4

How can you tell urethritis from cystitis?

Answer 4

Cystitis does not give urethral discharge

Question 5

What is the most accurate test for pelvic inflammatory disease?

Answer 5

Laparoscopy, although it is usually diagnosed clinically.

Question 6

How do you treat PID? Give inpatient and outpatient

Answer 6

Inpatient: cefoxitin or cefotetan (anaerobic) + doxy

Outpatient: ceftriaxone and doxy

Question 7

How do you diagnose syphilis?

Answer 7

Dark field microscopy, RPR or VDRL

Question 8

What are the best initial and most accurate test for herpes Symplex

Answer 8

Tzank prep: best initial

Viral culture: most accurate

Question 9

What is Argyll Robertson pupil

Answer 9

Finding of neurosyphilis. Accommodates, but does not react to light

Question 10

What is the most sensitive test for neurosyphilis in the cerebrospinal fluid?

Answer 10

FTA (free treponemal antibody) is nearly 100% sensitive

Question 11

What’s the difference in treatment between tertiary syphilis and primary or secondary syphilis?

Answer 11

IV PCN for tertiary
IM for the other two

Give doxy if PCN allergic

Question 12

What is the Jarisch-Herxheimer reaction?

Answer 12

Transient fever and worsening of symptoms after treating syphillis
Will spontaneously pass, give antipyretics

Question 13

How do you treat neurosyphilis in pregnant women

Answer 13

Desensitization therapy

Question 14

How do you treat genital warts

Answer 14

Cryotherapy and Iniquimod

Question 15

How do you treat crabs

Answer 15

With permethin same as scabies

Question 16

What are the best initial and most accurate test for a urinary tract infection?

Answer 16

Best initial: urinalysis with more than 10 white blood cells

Most accurate: urine culture

Question 17

How do you treat urinary tract infection

Answer 17

Nitrofurantoin (3 days if no anatomic abnormality)

Tmp/smx

Question 18

What is the best initial therapy for pyelonephritis?

Answer 18

Floroquinolones

Question 19

What is the main difference between treating prostatitis and cystitis?

Answer 19

Duration of therapy. Short for cystitis, long for prostatitis

Question 20

What is the next step in treating a pyelonephritis that does not resolve with appropriate therapy?

Answer 20

Drainage of the perinephric abscess and culture of the fluid

Question 21

What is always the most likely diagnosis with fever and a heart murmur?

Answer 21

Endocarditis. Confirm with echo and blood cx

Question 22

Name the findings of endocarditis

Answer 22

Fever, murmur, janeway lesions, splinter hemorrhages, roth spots, osler nodes, septic lung emboli

Question 23

What should somebody who has a Clostridium septicum endocarditis get next?

Answer 23

Colonoscopy. This bug is associated with diverticuli and colon cancer (like strep bovis)

Question 24

How to diagnose endocarditis with negative cultures?

Answer 24

Oscillating vegetation on echo or:

fever greater than 100.3+ high-risk patient + signs of embolus

Question 25

Best initial treatment for endocarditis?

Answer 25

Vancomycin and gentamicin

Question 26

When is endocarditis prophylaxis appropriate?

Answer 26

Anatomic defect and risk of bacteremia (dental work, respiratory surgery).

Use amoxicillin

Question 27

Manifestations of Lyme disease

Answer 27

Target rash, knee joint pain, bells palsy, transient AV block

Doxy is mainstay of tx

Question 28

What are the best initial and confirmatory test for HIV

Answer 28

ELISA, then western blot

Question 29

At what CD4 level is PCP pneumonia a concern?

Question 30

What is the prophyllactic treatment for the newborn of an HIV+ mother?

Answer 30

Zidovudine