GYN infections (5 stars esp STDs)

Question 1

Clue cells

Answer 1

Bacterial vaginosis (Gardnerella vaginalis)

Question 2

Greenish frothy vaginal discharge

Answer 2

Trichomonas

Question 3

Pseudohyphae + budding yeast on KOH prep

Answer 3

Candida albicans

Question 4

Strawberry cervix + foul smelling vaginal discharge

Answer 4

Trichomonas

Question 5

Fishy odor of KOH prep

Answer 5

Bacterial vaginosis (Gardnerella vaginalis)

Question 6

“Cottage-cheese” thick, white vaginal discharge

Answer 6

Candida albicans

Question 7

Vaginal pH >4.5 (high)

Answer 7

Bacterial vaginosis or Trichomonas

Question 8

Motile organisms on KOH prep

Answer 8

Trichomonas

Question 9

Treatment bacterial vaginosis

Answer 9

Metronidazole

Question 10

Treatment trichomonas vaginalis

Answer 10

Metronidazole + sexual partner

Question 11

Treatment candida vaginitis

Answer 11

Topical -azole or oral fluconazole

Question 12

Generalized macular rash + fever + hypotension + desquamation of palms and soles

Answer 12

Toxic shock syndrome

Question 13

Treatment TSS

Answer 13

Clindamycin or penicillinase-resistant B-lactam + vancomycin for MRSA

Question 14

UTI or cervicitis + no organisms on gram stain/culture

Answer 14

Chlamydia (intracellular)

Question 15

Thayer-Martin culture

Answer 15

Neisseria gonorrhea

Question 16

MC reportable STD

Answer 16

Chlamydia

Question 17

Treatment chlamydia or gonorrhea

Answer 17

Treat for both
C - Azithromycin (or doxycycline)
G - Ceftriaxone

Question 18

Lower abdominal pain w/i days of menses + cervical motion tenderness (chandelier sign) + adnexal tenderness

Answer 18

PID

Question 19

PID + RUQ tenderness

Answer 19

Fitz-Hugh-Curtis (liver involvement)

Question 20

MCC PID

Answer 20

Gonorrhea or chlamydia

E coli, bacteroides, strep

Question 21

Labs for syphilis

Answer 21

Treponema spirochete visualized on dark-field microscopy
VDRL or RPR (screening)
FTA-ABS or MHA-TP (treponemal specific) for confirmation
Cannot be cultured

Question 22

Primary syphilis

Answer 22

Painless chancre (ulcer), heals spontaneously w/i 9 weeks

Question 23

Secondary syphilis

Answer 23

Fever, HA, malaise, lymphadenopathy
Maculopapular rash on palms and soles
Papules on mucus membranes, genitals (condyloma lata)
Resolves spontaneously

Question 24

Tertiary syphilis

Answer 24

After latent period of 1-30 years
Gummas of skin, bone, liver
Tabes dorsalis (loss of 2-pt discrimination and proprioception, shooting pains), paresthesias
Argyll-Robertson pupil (small, does not contract to light, contracts to accommodation)
Tree-bark aortitis (ascending aorta aneurysms) and AV insufficiency

Question 25

Treatment PID

Answer 25

Empiric antibiotics til culture returns

Question 26

Treatment syphilis

Answer 26

Penicillin G

Question 27

HPV types

Answer 27

1-4: skin warts 6, 11: genital warts 16, 18: cervical cancer 16: anal, penile, vulvar, head and neck cancer associations

Question 28

Cauliflower-like warts on genital region

Answer 28

HPV

Question 29

Treatment HPV warts

Answer 29

Podyphyllin, trichloracetic acid, topical 5-FU, a-IFN | Injection, cryotherapy, laser therapy, excision

Question 30

Small papule -> painful ulcer w/ gray base and possible bubo formation (inguinal swelling)

Answer 30

Chancroid (Haemophilus ducreyi)

Question 31

Treatment chancroid

Answer 31

Ceftriaxone or azithromycin

Question 32

Malaise, fever, HA + papule -> painless ulcer + unilateral inguinal bubos, can have fistulas, abscess esp if anal

Answer 32

Lymphogranuloma venereum (L1-3 chlamydia serotypes)

Question 33

Treatment LGV

Answer 33

Doxycycline

Question 34

Papule -> painless ulcer w/ beefy red base, irregular borders, easy bleeding w/ Donovan bodies (intracellular gram negative rods) on Giemsa stain of lesion

Answer 34

Granuloma inguinale (Klebsiella granulomatis)

Question 35

Treatment granuloma inguinale

Answer 35

Doxycycline

Question 36

Genital ulcers (painful/painless)

Answer 36

``` Some Girls Love Licorice but Fellows Hate Candy Syphilis, Granuloma inguinale, Lymphogranuloma venereum = painLess ``` painFul Herpes Chancroid