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UG Tract Flashcards

1
Q

Normal vaginal flora varies according to what changes at different ages?

A

Hormonal influences

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2
Q

What is the primary bacteria in the vaginal flora in the childbearing years?

A

Lactobacillus

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3
Q

What is the morphology and gram stain of lactobacillus? Aerobic?

A

Gram positive, microaerophilic rods

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4
Q

Does lactobacillus causes UTIs? Why/why not?

A

No, b/c they cannot grow in urine

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5
Q

What causes the low pH found in the vagina?

A

Lactic acid fermentation by lactobacilli

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6
Q

Why is lactobacillus the main organism in the vagina?

A

Lowers pH, killing off other bacteria

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7
Q

What happens to lactobacillus as women age?

A

Becomes less prominent

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8
Q

How much does menstruation change normal vaginal flora?

A

Transient changes

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9
Q

What happens with a hysterectomy in regard to the normal vaginal flora? (3 species increase)

A

Increase in bacteroides fragilis, E.coli, and enterococcus species

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10
Q

What is BV?

A

Dysbiosis of bacterial vaginal flora, with overgrowth of anerobic species

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11
Q

What happens to [Lactobacillus] in BV infections?

A

Lowers

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12
Q

What are the symptoms of BV?

A

Asymptomatic

Burning, itching, pain, odor

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13
Q

Is BV an STD?

A

No

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14
Q

What are the risk factors for BV?

A

Oral sex
Douching
Smoking
Sex during menses

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15
Q

How do you diagnose BV?

A

Clue cells in vaginal prep

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16
Q

What is the discharge associated with BV?

A

White-grey milky appearance

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17
Q

What is the whiff test?

A

Adding KOH and smelling Fishy odor d/t release of amines

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18
Q

What do clue cells look like?

A

Granular looking epithelial cells

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19
Q

Clue cells are diagnostic for what?

A

BV

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20
Q

A vaginal pH above 4.5 is indicative of what? Why?

A

BV d/t lack of lactobacillus

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21
Q

What is the Nugent score?

A

Numerical score based on quantifying the types of bacteria present

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22
Q

What are the components of an amsel criteria?

A
  1. Discharge
  2. Clue cells
  3. Whiff test
  4. pH test
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23
Q

A lower Nugent score is (normal/abnormal)?

A

Normal

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24
Q

What are the complications of BV?

A
  1. Increases the risk for HIV/other STDs
  2. Sepsis post surgery
  3. Miscarriage
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25
What is the treatment for BV?
Oral metronidazole or clindamycin
26
What is vulvovaginal candidiasis caused by?
Yeast
27
What are the symptoms of vulvovaginal candidiasis?
Thick, odorless white vaginal discharge Pruritus
28
What is the discharge associated with vulvovaginal candidiasis?
Cottage-cheese like appearance
29
What is the criteria for complicated candidiasis?
more than 4 in one year
30
What does candida look like under the microscope?
Oval, yeast like from Pseudohyphae and aseptate hyphae
31
What does a germ tube indicate?
Candida albicans
32
What does the india ink stain indicate?
Cryptococcus neoformans
33
What is the most common yeast found in candidiasis?
Candida albicans
34
True or false: Candida albicans is normal host flora
True
35
What usually predisposes someone to candidiasis?
Recent Abx use
36
What else does Candida albicans cause? (4)
Diaper rash | Oral thrush
37
What are the two infections that can occur with Candida albicans in immunocompromised patients?
Esophagitis and disseminated if immunocompromised
38
What are the factors associated with increased susceptibiliy of candidiasis?
1. Oral contraceptive use 2. prego 3. DM 4. HIV 5. Abx
39
How do you diagnose candidiasis?
Microscope
40
What is the treatment for Candidiasis?
1-3 days of topical azole 7-14 days of oral fluconazole if complicated
41
What is trichomoniasis?
Gross parasite that does not produce cysts
42
What are the symptoms of trichomoniasis? Discharge?
Yellow-green frothy, foul smelling itching, dysuria
43
Men are asymptomatic or symptomatic with trichomoniasis infections? Women?
Men primarily asymptomatic Women more often display symptoms, but still usually not
44
Is trichomoniasis motile?
Yes, has undulating membrane
45
Is trichomoniasis aerobic?
Anaerobic
46
Does trichomoniasis have a cyst form? What is the consequence of this?
No, only protozoa/trophozoite form Can only spread via sexual contact
47
What is the pathogenesis of trichomoniasis?
Petechial hemorrhages on the cervix
48
Strawberry cervix is associated with what?
trichomoniasis
49
How do you diagnose trichomoniasis?
Seeing swimming organisms on a wet mount of discharge
50
Do you develop immunity to trichomoniasis?
No
51
What is the treatment for trichomoniasis? Who else should be treated?
Metronidazole (BOTH partners)
52
What is menstrual toxic shock syndrome? What is it caused by?
S. Aureus toxin production d/t tampons or wound
53
What is the gram stain and morphology of S. Aureus?
Gram positive cocci
54
Is staph catalase positive or negative? Coagulase?
Both positive
55
Is S. Aureus intracellular or not?
Intracellular
56
Does S. Auerues produce toxins? Is this relevant in toxic shock syndrome?
Yes, and yes
57
What is the toxin that S. Aureus produces in menstrual toxic shock? What type of toxin is it?
TSST-1 Superantigen (attaches to MHC class II)
58
What is the MOA of superantigens?
Binds to MHC class II, causing T cell acitvation and release of proinflammatory cytokines
59
What are the cytokines released in toxic shock syndrome?
TNFbeta, TNF-alpha IL-2
60
What are the symptoms of toxic shock syndrome? (5)
n/v/d Malaise Fever
61
What are the signs of TSS?
Hypotension Conjunctival erythema Sunburn rash Myalgias
62
How do you diagnose TSS?
Culture vaginal tract but NOT blood
63
What is the treatment for TSS?
Remove tampon | Beta-lactamase resistant PCN or vanco
64
What percent of pts fail to mount an antibody response to TSS? What is the consequence of this?
50% High likelihood for recurrence, so should avoid tampon use
65
What are the characteristic features of trichomonas vaginalis?
Undulating membrane | Flagella
66
Can trichmonas vaginals survive on fomites?
No
67
Which gram positive cocci grows in grapes? Which smells like grapes?
S. Aureus Smell = pseudomonas
68
What is erythroderma? Which disease that we discussed is associated with this?
Diffuse erythema, particularly on the soles and palms Toxin shock syndrome by Staph Aureus toxin

Microbio (50 decks)

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