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Kaplan ID > STDs > Flashcards

STDs Flashcards

1
Q

In men, what is the best initial test for dx of urethritis?

A

Urethral swab for gram stain and WBC, look for intracellular gram negative diplococci for N.gonorrhea

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2
Q

What is the most accurate test for urethritis

A

Urine for nucleic acid (NAAT) detects gonorrhea and chlamydia

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3
Q

Organisms causing urethritis?

A

N.gonorrhea
Chlamydia
Mycoplasma genitalium
Ureaplasma

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4
Q

Best initial test for dx of urethritis in women?

A

Self administered vaginal swab

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5
Q

What is tx for urethritis?

A

One drug for gonorrhea and one for chlamydia
Gonorrhea: cefixime (resistant to quinolones) or ceftriaxone
Chlamydia: azithromycin or doxy

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6
Q

Cervicitis px

A

Cervical discharge, strawberry cervix

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7
Q

Cervicitis tx

A

Ceftriaxone or cefixime and azithromycin or doxy

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8
Q

Cervicitis dx

A

Self administered cervical swab for NAAT

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9
Q

PID is caused by which bugs?

A

Gonorrhea, chlamydia

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10
Q

PID presentation

A

Lower abdominal tenderness, fever, cervical motion tenderness (found on bimanual exam), leukocytosis

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11
Q

Most specific tests for PID

A

Culture, DNA probe or nucleic acid amplification (NAAT)

Clarify need for treating the partner

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12
Q

How to determine resistance of organisms causing PID?

A

Culture

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13
Q

When to use laparoscopy in PID and why?

A

It is the most accurate test, use only if the dx is unclear, sx persist despite tx or there is recurring episodes for unclear reasons
It is very rarely done

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14
Q

PID tx?

A

Inpatient: cefoxitin or cefotetan combined with doxy
Outpatient: ceftriaxone and doxy (possibly with metronidazole)

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15
Q

Patient has PID but anaphylaxis to penicillin, what is the tx?

A

Levofloxacin and metronidazole in outpatient

Clindamycin and gentamycin in inpatient

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16
Q

In ulcerative genital disease, how to make a ddx with px and hx?

A

Painless ulcer : syphillis
Painful ulcer : chancroid (hemophilus ducreyi)
Tender and supurrating lymph nodes : lymphogranuloma venereum
Painful ulcer with prior vesicules : herpes simplex

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17
Q

Best initial test for syphillis?

A

Dark field microscopy (best in primary) if positive, no further testing is necessary!, VDRL or PCR (75% sensitive only), FTA or MHA-TP (for confirmation only)

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18
Q

Dx test for chancroid?

A

Stain and culture (special media): pleomorphic gram neg coccobacillus

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19
Q

Dx test for lyphogranuloma venerum?

A

Complement fixation titers serology, nucleic amplification testing on swab

20
Q

Dx for herpes simplex?

A 
Tzank prep (best initial test): multinucleated giant cells
Viral culture : most accurate test
21
Q

Tx for syphillis?

A

One dose IM benzathine penicillin

22
Q

Tx for syphillis if the patient is allergic to penicillin?

A

Doxy

23
Q

Tx for chancroid?

A

Single dose of azithromycin

24
Q

Tx for lymphogranuloma venerium

A

Doxy

25
Q

Tx for herpes simplex

A

Acyclovir, valacyclovir, famciclovir

26
Q

How to detect aciclovir resistant herpes?

A

Viral sensitivity testing

27
Q

What is the tx for aciclovir resistant herpes?

A

Foscarnet

28
Q

Woman comes to the clinic with multiple painful genital vesicles, what is the next best step?

A

Go straight to tx (not tzank prep), gove acyclovir orally

29
Q

Primary syphillis sx

A

Painless genital ulcer, can become painful is secondarily infected, painless adenopathy, chancres will heal spontaneously but use penicillin to prevent secondary/tertiary

30
Q

Secondary syphillis sx and presentation

A

Rash on palms and soles
Alopecia areata
Mucous patches
Condylomata lata

31
Q

Tertiary syphilis presentation

A

Neurosyphilis: meningovascular (stroke at a young age); tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil,
Gummas (skin and bone lesions)
Aortitis (aortic regurgitation, aortic aneurysm)

32
Q

What could cause a false positive VDRL/RPR?

A

Infection, older age, injection drug use, AIDS, malaria, antiphospholipid syndrome and endocarditis

33
Q

Titers for VDRL or RPR are reliable at?

Rarely false positive at?

A

Reliable at >1:8 (lower is often false positive)

Rarely false positive at >1:32

34
Q

Treatment of primary and secondary syphilis

A

Single dose IM injection of penicillin, oral doxy if allergic

35
Q

Tx of tertiary syphilis?

A

IV penicillin, desensitization if allergic

36
Q

What is the Jarish-herxheimer reaction?

A

Fever, headache, myalgiad after treatment

Give aspirin and antipyretics, it is benign and will pass

37
Q

When to desensitize patients that have syphilis?

A

In neurosyph if penicillin allergic or pregnancy only

38
Q

How to diagnose genital warts (condylomata acuminata)

A

Visual appearance (no biopsy, serology or stains)

39
Q

How to treat genital warts?

A

Remove it by cryotherapy, surgery if large, laser, podophyllin or trichloroacetic acid
imiquimod (apply locally): immunostimulant

40
Q

How does pediculosis presents

A

Itchy little “black dots” , visible on hair baring areas (axilla, pubis)

41
Q

How to treat crabs?

A

Permethrin

42
Q

How do scabies present?

A

Visible burrows in web spaces (between fingers and toes), around nipples, near genitals

43
Q

How to dx scabies?

A

Scrape and magnify

44
Q

Tx for scabies?

A

Permethrin
If widespread scabies: oral ivermectin
Severe disease needs repeat dosing

45
Q

What are the common sx between cystitis and urethritis and how to differentiate them based on symptomatology?

A

Dysuria, frequency and burning are common sx

Cystitis does NOT have discharge

Kaplan ID (11 decks)

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