Exam #6: Review Flashcards Preview

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Flashcards in Exam #6: Review Deck (68):
1

List the important characteristics of the Chlamydiaceae family.

Lack peptidoglycan
Stain weakly Gram (-)
Contain LPS with weak endotoxin activity

2

What does C. trachomatis have a tropism for?

Nonciliated, columnar, cuboidal, & transitional epithelial cells of the:
- Urethra
- Endocervix
- Endometrium
- Fallopian tubes
- Anorectum
- Respiratory tree
- Conjunctiva

3

What is trachoma?

Chronic inflammatory/ granulomatous process of the eye leading to:
- Corneal ulceration
- Scarring
- Pannus formation (abnormal layer of granulation tissue)
- Blindness

4

What is adult inclusion conjunctivitis?

Acute conjunctivitis seen in sexually active adults that is characterized by:
- Mucopurulent discharge
- Dermatitis
- Corneal infiltrates
- Corneal vascularization (chronic disease)

5

What are the symptoms of C. trachomatis infections in men & women? What is the important difference?

Men=
- Dysuria
- Mucopurulent discharge

Women= MOST ASYMPTOMATIC carriers
- PID

6

What are the complications of C. trachomatis infection in men?

1) Epididymidis
2) Prostatitis
3) Reiter Syndrome

7

What is Reiter Syndrome?

1) Urethritis
2) Conjunctivitis
3) Polyarthritis
4) Mucocutaneous lesions

8

What are the symptoms of LGV?

Small, painless ulcers that swell
Painful inguinal lymph nodes that ulcerate

9

How is C. trachomatis diagnosed?

*After obtaining a SCRAPING of the location:

1) Giemsa stain
2) Iodine for reticulate bodies
3) Immunoflourescence of elementary bodies

and

4) NAAT, which is the gold standard

10

List six virulence factors associated with N. gonorrhoeae. What is unique about some of these virulence factors?

1) Pilin= attachment
2) Por protein= promotes intracellular survival
3) Opa protein= attachment
4) LOS= endotoxin (stimulates TNF-alpha & chemokine response)

*These undergo antigenic variation

5) IgA protease
6) B-Lactamase

11

What complications can be seen in N. gonorrhoeae infection in men & women? (Note disseminated gonorrhoeae)

Men=
- Epididymidis
- Prostatitis
- Periuretheral abscess

Women=
- Salpingitis
- Tubovarian abscess
- PID

12

What are the symptoms of disseminated N. gonorrhoeae?

Septicemia
Gonococcal arthritis
Pustular rash

*Leading cause of purulent arthritis in adults

13

How is N. gonorrhoeae diagnosed?

1) Direct smear= Gram negative bean-shaped diplococcus in neutrophils
2) Culture and growth from uretheral or cervical scrapings
3) NAAT

14

How is N. gonorrhoeae treated?

Ceftriaxone + prophylactic Chlamydia treatment i.e. azithromycin or doxycycline

15

What are the characteristics of Treponema pallidum?

Thin Gram (-) spirochete
Motile
Microaerophilic

16

How is sphyilis diagnosed?

Dark field microscopy
Direct fluorescence
*****Serology*****
(Treponemal & Non-teponemal- cardiolipin)

17

What are the symptoms of secondary syphilis?

Secondary syphilis= systemic syphilis

- Flu-like syndrome
- Prominent desquamating lesion on palms of hands & soles of the feet
- Condylomata lata

18

What are symptoms of tertiary syphilis?

- Gummas
- Diffuse chronic inflammation
- Can affect any tissue/ organ

19

What are the symptoms of congenital syphilis?

Chronic rhinitis lead to saddle nose
Hutchinson malformation (teeth)
Bone malformation
Blind & Dead
Cardiovascular syphilis

20

What are the most common causes of NGU? List the characteristics of these organisms.

Mcoplasma genitalium ("fried-egg" morphology)- No doxy
Ureaplasma urealyticum

- NO cell wall
- Not stained
- Pleomorphic
- Membrane contains sterols

21

How is Chancroid treated?

Macrolides

22

What causes Donovanosis?

Klebsiella granulomatis

23

What are the symptoms of Donovanosis?

Hard, ulcerated, and painless lesion that bleeds easily & has a tendency to cause significant genital damage

24

How is Donovanosis diagnosed?

Donovan bodies

25

List the characteristics of Lactobacillus. What is unique about where it can grow?

Gram (+) rod
Microaerophilic or anaerobic

Cannot grow in urine; thus, it DOES NOT cause UTI

26

What are the risk factors for bacterial vaginosis?

- Oral sex
- WSW
- Sex during menses
- New or multiple sex partners
- Smoking
- IUD

27

What are the four amsel criteria for bacterial vaginosis diagnosis?

1) Discharge (white-gray)
2) Clue cells
3) Whiff test
4) pH greater than 4.5

Remember, "I don't have a clue why I smell fish in the vagina garden"

28

What are the complications of bacterial vaginosis?

1) Increased STD & HIV risk
2) Increased STD & HIV transmission risk
3) Increased development of post-surgical infections
4) Increased risk of pregnancy complications

29

How is bacterial vaginosis treated?

Oral metronidazole
Clindamycin

30

What increased the risk for vulvovaginal candidiasis?

*****Antibiotic administration*****
- Systemic corticosteroids
- Oral contraceptives
- Pregnancy
- DM
- HIV infection

31

How is candidia albicans diagnosed?

- Microscopic examination with 10% KOH
- Growth & culture on "Nickerson medium"
- Germ tube test

32

What are the symptoms of Trichomoniasis?

Vaginitis
Ictching
Burning
Dysuria

"Yellow-green, frothy, foul-smelling discharge"

33

What is another hallmark finding of Trichomonas vaginalis?

Strawberry cervix

This is due to epithelial cell descturction in the GU tract that leads to neutrophil influx & petechial hemorrhage

34

What are the presenting symptoms of TSS?

Malaise
Fever
Nausea
Vomiting
Diarrhea

*****Erythroderma*****

35

How is TSS treated?

1) Remove tampon
2) Supportive therapy (shock)
3) Beta-Lactamse resistance PCN or vancomycin

36

What are the symptoms of prostatitis?

Lower back pain
Perirectal pain
Testicular pain

37

What are some of the risk factors for developing a UTI?

Sexual intercourse
Catheterization (CA-UTI)
BPH
DM
Pregnancy

38

What bacteria most commonly cause community acquired UTI?

UPEC
S. saprophyticus

39

What bacteria are hospital acquired UTIs associated with?

Klebsiella
Proteus mirabilis
Pseudomonas aeruginosa

40

What are serologic makers of enterobacteriaceae?

O, H, & K antigens

O= LPS
K= capsular
H= flagella

41

What virulence factors are associated with enterobacteriaceae?

Endotoxin (LPS)
Antimicrobial resistance

42

What virulence factors are associated with UPEC?

Adhesin
Hemolysin
LPS/ Endotoxin

Type I pili (mannose)
P-pili ("sugar")

43

What virulence factor is associated with Proteus mirabilis? What is the clinical implication?

Urease

Urease--> alkanization of the urine that can cause precipitation of organic & inorganic compounds i.e. leading to renal stones

44

How is a Proteus UTI treated?

TMP-SMX

45

How is pseudomonas aeruginosa diagnosed?

Blue-green cyan pigment

46

How is pseudomonas UTI treated?

Multiple antibiotics

47

What risk factors are associated with enterococsus UTI?

Hospitalization
Treatment with broad spectrum antibiotics

48

What infections are associated with enterococcus aside from UTI?

Peritonitis
Endocarditis

49

How is uncomplicated cystitis treated?

TMP-SMX

50

How is pyelonephritis treated?

Depends whether the causative organism if Gram positive or Gram negative.

Gram positive= Amoxicillin
Gram negative= Fluoroquinolones

51

What are the requirements for treating asymptomatic asymptomatic bacteriuria? How is it treated?

1) Pregnant women
2) Prior urologic surgery
3) Renal transplant

- Amoxicillin
- Cephalexin
- Nitrofurantoin

52

What are the symptoms of acute HIV infection?

3-6 weeks post-infection there will be a mononucelosis-like syndrome with:

Fever
Malaise
Arthralgia
Lymphadenopathy
Sore throat
Rash

53

What are common HIV associated infections & what causes them?

Oral Hairy Leukoplakia= EBV
Pneumonia= Pneumocytis jevori & Mycobacterium Tuberculosis
Trursh= candidia albicans
CMV retinitis= CMV
Neoplasm= kopasi's sacrcoma, B-cell lymphoma
Diarrhea= cryptosporidium & isopsera belli

54

List the classes of antiretroviral drugs.

- Attachment inhibitors= chemokine receptor antagonists (gp120)
- Fusion inhibitors= gp41
- Reverse transcriptase inhibitors
Nuceloside
Non-nucleoside
- Integrase inhibitors
- Protease inhibitors

55

What is the current standard of care for ARV therapy?

2x NTRIs +

1) NNRTI
2) II
3) PI

56

What are the symptoms of HSV genital infection?

Genital lesion
Fever
Inguinal lymadenopathy
Malaise

57

How does the lesion seen with HSV appear?

The lesion progresses from macules to papules, vesicles, pustules, & ulcers

58

List the characteristics of HSV.

Herpesvirus family
Enveloped
dsDNA

HSV-2 is most common

59

What are the three presentations of Neonatal Herpes Infection?

1) Localization to skin, eyes, & mouth
2) Encephalitis
3) Disseminated infection

60

How is HSV diagnosed?

Clinical appearance
Tzanck smear
PCR
Immunohistochemistry to detect antigens

61

Generally, how is HSV infection treated based on different regions that can be infected?

Oral= NOT
Eye= topical antiviral
Neonatal= IV antiviral
Genital= oral antiviral (long term if recurrent)

62

List the characteristics of HPV.

Papovirus family
dsDNA
non-enveloped

63

What is the medical term for genital warts?

Condyloma acumanitum

64

What are the descriptive features of genital warts?

Hyperkerototic
Firm
Expohilic papules

65

What serotypes of HPV cause Plantar Warts?

1 & 4

66

Which HPV serotypes have the highest association with cancer?

HPV 16 & 18

67

How is HPV diagnosed?

Main tool for diagnosis is the Pap smear; cells are removed during pelvic examination & placed directly onto glass slide with fixative
- Mild dysplasia involving lower 1/3 of epithelial= cervical intraepithelial neoplasia I (CINI)
- Dysplasia of the entire epithelium= carcinoma in situ (CIN3)
- Dyplasia + breach of the basal membrane= invasive squamous cell carcinoma

68

How is HPV treated?

Low grade lesions=
- Cauterization
- Cryotherapy
- CO2 laser therapy
- Loop excision

Advanced (carcinoma in situ +)=
- Hysterectomy
+/- radiation and/or chemotherapy

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