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ENRP II > Gynecological and Pregnancy Related Infections Part 1 > Flashcards

Gynecological and Pregnancy Related Infections Part 1 Flashcards

(65 cards)

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1
Q

what is the differential diagnosis of vaginal discharge

pathologies that lead to vaginal discharge

A

Bacterial Vaginosis, Candida, Trichomoniasis, Gonorrhea, and Chlamydia

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2
Q

to help narrow the differential diagnosis of vaginal discharge we would utilize?

additional tests used

A

Wet mount, pH, PCR/NAAT and pregnancy teset

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3
Q

PCR is utilize to identify gonorrhea, trichmonasis and chlamydia, what kind of PCR for all 3 is used?

A

endocervical swab, vaginal swab or urine for gonorrhea and chlamydia

vaginal or first voided urine for trichomoniasis

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4
Q

dont forget to check a ____ test when evaluating gynecological complaints because our treatment might be altered

A

pregnancy

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5
Q

what is a clue cell

A

vaginal epithelial cells with bacteria obscuring its borders

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6
Q

what is a postassium hydroxide whiff test

A

when we swab the vaginal place the discharge on a slide and drop postassium hydroxide onto the discharge

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7
Q

what are the three common causes of vaginitis

A

bacterial vaginosis, candidiasis, trichmonasis

bacterial, fungal, parasitic

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8
Q

what are the signs of bacterial vaginosis

discharge, bacterial pH, whiff test, NaCL wet mount

A

homogenous think off white foul smelling discharge
pH >4.5
positive whiff test
clue cells with few RBCs

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9
Q

what is the criteria for diagonsis bacterial vaginosis

A

amsel criteria with 3/4 present

  1. discharge
  2. vaginal pH >4.5
  3. posititve whiff test
  4. clue cells on saline wet mount
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10
Q

what is the pathology of bacterial vaginosis

A

overgrowth of anerobic bateria which replaces normal bacterial flora

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11
Q

bacterial vaginosis is not a sexually transmitted disease BUT is associated with ?

2 things

A

increased sexual activity and concomittant secually transmitted diseases

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12
Q

what concomitant secually transmitted infections are associated with BV

A

HIV, gonorrhea, chlamydia, herpes, HPV

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13
Q

____ has a slight anti-estrogenic effect wich can predispose you to changes in the vaginal flora

A

smoking

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14
Q

normal vaginal flora consits of ______

bacteria

A

lactobacilli

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15
Q

lactobacilli are ____ anaerobic gram _____ bacilli that predominate in the vagina shortly after menses

A

aerotolerant

gram negative

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16
Q

lactobacilli create ____ and ____ which lowers the pH

A

hydrogen peroxide and lactic acid

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17
Q

pH of the vagina rises when there is contraceptive devices implanted, secual intercourse etc. and there is a shift in bacteria to ?

A

anerobic coccobacilli (clue cells, cover squamous cells)

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18
Q

what are the typical microorganisms that cause bacterial vaginosis?

A

anerobic and facultative anerobic coccobaccili like** gardnerlla vaginalis**, prevotella species, and atopbium vaginae

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19
Q

gardnerella vaginalis plays a pivotal role in creating a ____ that allows other bacteria to create a bacterial mass

A

biofilm

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20
Q

what causes the fishy smell in BV

A

the anerobes and facultative anerobes merge together to create volatile, malodorous amines

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21
Q

what are the choice of drugs to treat BV?

A

metronidazole, tinidazole, clindamycin

all in PO or vaginal cream formations

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22
Q

what is the MOA of nitroidazoles (metronidazole and tinidazole)

A

causes DNA damage by first being acitvated by nitroreductase and releasing free radicals that causes loss of DNA helical structure, strand breakage, and inhibits protein synthesis (DNA replication is lost)

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23
Q

mtronidazole and tinidazole causes cell death in susceptible organisms like

A

trichomonas

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24
Q

what are the side effects of nitroimidazoles

A

Disulfuram-like reaction with alcohol (flushing, vomiting, headache), CNS distubances, nausea/bloating/cramping

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25
metabolism of nitroimidazoles is through?
glucuronidation
26
nitroimidazoles are eliminated how?
through the urine unchanged
27
does nitroimadizoles penetrate the CSF
yes, and abcessess too
28
clindamycin is a ________ that is used when there is a patient allergic to ____
lincosamide allergic to penicillin
29
clindamycin covers? | what type of bacteria
gram positives and anaerobes
30
clindamycin is used to treat ____ and to decrease the risk of premature births in women with BV
toxic shock syndrome **pelvic inflammatory disease too
31
MOA of clindamycin
binds to the 50s bacterial subunit to inhibit transpeptidation | transpeptidation is peptide chain elongation
32
adverse affect of clindamycin
C.diff which can lead to overgrowth and release of toxins
33
does clindamycin penetrate the csf?
no but does penetrate abcesses
34
what are the presentations of candidiasis | pH, discharge, NaCL wet mount, whiff test, KOH wet mount
ph<4.5 thick clumpy cottage cheese discharge negative whiff test KOH wet mount has psuedohyphae no cervitis erythema on vulva
35
to better assess candidia on wet mount we should use?
KOH (postassium hydroxide rather than NACL)
36
is candadiasis a sexually transmitted disease
no
37
Risk factor for vulvovaginal candidiasis ?
diabetes, high estrogen states, immunosuppresion, antibiotics (fluroquinolones)
38
in diabetes candidia can thrive in ____ glucose environments
higher
39
HIV and immunosuppresion both decrease ____ response to infection by candida
immune
40
pregnancy and post-menopausal estrogen therapy can increase the risk of candida due to ____ states
increased estrogen
41
antibiotics can cause candida because they ?
inhibit normal flora and favor the growth of candidia species
42
symptomatic infection with candida is only seen with?
invasion of the squamous cells (massive overgrowth)
43
________ is the most common cause of vulvovaginal infections
candida albicans (also could be candida glabrata due to fungal drugs being used to being target albicans)
44
over the counter azoles that treats candiasis
clotrimazole, miconazole, ticonazole | all vaginal suppositories
45
prescription vaginal suppositories for candidiasis
terconazole and butoconazole
46
oral prescription drug to treat candidiasis?
flucanazole
47
MOA of azoles (anti-fungal)
inhibit conversion of lanosterol to ergosterol by CYP450 system | cant form fungal cell wall, cell membrane disruption ## Footnote bind to active site of 14a demethylase CYP450 enzyme
48
flucanazole side effects | azoles
potential for fetal harm/birth defects, prolong QT interval (torsades)
49
QT prolongation caused by other medicines may be amplified via the flucanazole-mediated inhibition of ?
cytochrome P450/(CYP3A4)
50
flucanazole given with erythromycin can cause?
cardiotoxicity, sudden heart death
51
flucanazole should be adminsitered with caution to patients with ____ dysfunction
renal dysnfunction
52
azole antifungals are ____ and ____ of the CYP3A4 family
inhbitors and substrates ## Footnote increases the serum concentrations of numerous drugs and can lead to potentially serious and lethal drug-drug interactions
53
what is the primary route of excretion for flucanzole | azole (antifungal)
renal excretion ## Footnote patients with liver or renal failure are at increased risk for drug drug interactions due to not being able to metabolize the drug
54
dyspurina
pain with sex
55
vaginitis tests
wet mount, pH
56
cervitis tests
PCR/NAAT
57
what are the presentations of trichmoniasis | discharge, cervix findings, pH, whiff test, NACL wet mount
green/yellow malodorous discharge cervical petichiae (strawberry cervix) pH>4.5 positive whiff test NaCl wet mount with motle flagellated protazoa
58
trichomoniasis is the most common ________ sexually tranmitted disease
nonviral
59
trichomonasis is associated with other sexually transmitted diseases like ?
HIV and HPV
60
what increases the risk for trichomoniasis
multiple sexual partners
61
trichmonas vaginalis is a flagellated pear shaped ________
protazoan ## Footnote no cyst formation so it does not survive outside the body
62
____ are the only natural hosts of trichomonas vaginalis
humans
63
T. vaginalis reproduces through
binary fission ## Footnote asexual replication where the organism splits in half*** infect squamous epithelium
64
treatment of trichmoniasis
treat any sexual partners to present reinfection metroidazole and tinidazole ## Footnote use mitronidazole in pregnancy
65
you should retest patients with trichomoniasis when ?
2 weeks to 3 months after completing treatment

ENRP II (25 decks)

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