You Nasty! Flashcards by Briana Echols

TORCH

Toxoplasmosis
Other (syphilis)
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus (HSV)

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What is a an important contributor to early and later childhood morbidity

infectious acquired in utero or during birth process

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What are the only two prenatal screenings done in the U.S.

syphilis and rubella

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How does Toxoplasmosis present in the baby?

Triad:
Chorioretinitis
Hydrocephalus
Intracranial calcifications

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What is a late finding in toxoplasmosis due to failure to treat

chorioretinitis

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What is seen in late finding for toxoplasmosis

intellectual disability, deafness, seizures and spasticity

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What is the treatment for Toxoplasmosis

Pyrimethamine and Sulfadizine (folinic acid leucovorin)

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Syphilis presentation in the baby?

asymptomatic at birth

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How do babies get syphilis?

mother received no prenatal care, no PCN, or inadequate treatment before/during birth

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Babies <2 show what syphilis manifestations?

syphilitic rhinitis (snuffles), maculopapular rash (palms), heptaosplenomegaly

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Babies > 2 show what syphilis manifestations?

saddle nose, hutchinson teeth, saber shins, mulberry molars

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Treatment for syphilis?

paraenteral penicillin

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Rubella presentation in the mother?

mild, self limited illness

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CRS presentation in the child?

sensorineural deafness, cardiac malformations, radiolucent bone disease, blueberry muffin, growth retardation

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Where is CRS usually seen?

in infants who mothers emigrated from countries w/ no rubella vaccine

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How is CRS treated?

Prevention is most important for management

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Children with CRS are contagious until….

1yr

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CMV presentation in baby?

asymptomatic, w/ 10% of symptoms

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What is the most common congenital viral infection

Cytomegalovirus (CMV)

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How does the mother get CMV?

close contact w/ young children, daycares

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What is the most common defect in CMV babies?

Sensorineural hearing loss (1/3 detected @ birth)

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CMV children are identified solely on the basis of what?

failed newborn hearing screen

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What is the treatment for life threatening CMV?

Ganciclovir IV

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What is the treatment for non-life threatening CMV?

Valganciclovir oral

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What is the treatment for asymptomatic CMV?

NONE, antiviral is not needed!!

What are most cases of neonatal HSV infection?

Perinatally acquired HSV

How is perinatally HSV transmitted?

through infected maternal genital tract

How do perinatally infected HSV babies present?

normal @ birth

What ways do perinatally acquired HSV develop?

- Localized to skin, eyes, and mouth (SEM) - Localized CNS disease - Disseminated disease involving multiple organs

How does a congenital HSV baby present?

Triad: Skin vesicles Ulcerations Scarring Eye damage, severe CNS (microcephaly or hydranencephaly)

Treatment for Herpes?

Acyclovir

ZIKA presentation in mama?

asymptomatic | low grade fever, rash, arthralgia, conjuctivitis

ZIKA presentation in baby?

microcephaly, arthrogryposis, facial disproportion

When is the greatest risk for ZIKA?

1st trimester

Treatment for ZIKA?

NONE, supportive

What are the two most important approaches to preggo patient?

Timely diagnosis, high index of suspicion

3 viral vulvar lesions?

Condyloma acuminata Molluscum Contagiosum HSV

Which HPV strains cause genital warts

6 and 11

Treatment for condyloma acuminata?

patient- Imiquimod cream, Podofilox gel, Sinecatchins | provider- TCA, cryotherapy, surgical removal

Mollusucum contagiosum is caused by what virus?

pox virus

Mollusucum contagiosum treatment?

resolves in 6-12 mo or up to 4yrs physical removal: cryotherapy, curettage, laser oral: cimetidine topical: podophyllotoxin cream (NOT FOR PREGGO)

Treatment for initial, episodic, and suppressive therapy for genital HSV?

Acyclovir or Valacyclovir

Treatment for intital epsoide of HSV?

Acyclovir oral | Valacyclovir

Treatment for episodic therapy of HSV?

Acyclovir oral | Valacyclovir oral

Treatment for suppressive therapy of HSV?

Acyclovir oral | Valacyclovir oral

3 bacterial vulvar lesions?

Folliculitis Chancre Syphilis Chancroid

What two bugs cause folliculitis?

Staph aureus, pseudomonas aeruginosa (hot tub)

Treatment for folliculitis?

resolves 2 wks avoid shaving, warm compress topical abx: mupirocin oral abx: dicloxacillin

Syphilis treatment?

Bezathine penicillin G IM single dose

Followup for syphilis period?

6 and 12 months

Diagnosis of syphilis?

Nontreponemal test (VDRL or RPR) and Treponemal test (FTA-ABS)

What causes Chancroid?

Haemophilus ducreyi

What two test if negative may lead to a chancroid diagnosis?

syphilis and HSV

Treatment for chancroid?

Azithromycin | Ceftriazone

Follow-up for chancroid?

re-examine 3-7 days

Candidiasis is caused by what?

Candida albicans (90%)

Whom are candidiasis infections more likely seen?

preggo, diabetics, obese, immunosuppressed, OCP, abx, steroids

Symptoms of a candidiasis infection

itching, burning, irritation

How does the discharge look in a candidiasis infection?

white curdy, cottage cheese, thick

What is seen on wet mount for candidiasis?

hyphae and buds

Treatment for candidiasis?

Oral fluconazole 150mg x1 or Imadizoles

MC bacterial infection organism?

Gardnerella vaginalis

What is seen on wet mount for bacterial infection?

clue cells

Treatment for bacterial infection?

Metronidazole gel or Clindamycin cream

How does the discharge look in a bacterial infection?

yellow, gray-white, thin adherent

Symptoms of a bacterial infection

fishy odor, gets worse after sex, ph>4.5, + whiff test

3 types of cervicitis?

Chlamydia | Gonorrhea Trichomoniasis

Most reported cervicitis?

Chlamydia

Treatment for chlamydia?

Azithromycin or doxycycline

Follow up for chlamydia?

All women retest 3mo

2nd most common cervicitis?

Gonorrhea

Symptoms of gonorrhea?

male- urethritis | female- overlooked

Appearance of discharge in gonorrhea?

greenish or yellow

Treatment for Gonorrhea?

Ceftraixone IM AND Azithromycin

What organism is associated w/ PID, endometritis, infertility, ectopic/preterm

Trichomoniasis vaginalis

Symptoms of trichomoniasis?

itching, burning, copious discharge, dysuria, dyspareunia, frothy discharge

Treatment for trichomoniasis?

Metronidazole oral OR tinidazole oral

Diagnosis of trichomoniasis?

petechiae "strawberry patches"

Two organisms that cause PID?

C. trachomatis and N. gonorrhea

Symptoms of PID?

Muscular guarding, cervical motion tenderness, adnexal tenderness, pelvic exam, fever, chills

PID parenteral treatment?

Cefotetan IV or Cefoxitin IV PLUS Doxy IV

PID outpatient treatment?

Ceftriaxone IM x1 PLUS Doxycycline +/- Metronidazole for 14dy