infections (non pregnancy)

Question 1

indications for hospitalization for PID

Answer 1

1. Pregnancy
2. failed outpatient treatment
3. inability to tolerate oral medications
4. non compliant
5. severe presentation (high fever, vomiting
6. complications (eg. tubo-ovarian abscess, perihepatitis)

Question 2

outpatient regimen fof PID

Answer 2

• IM ceftriaxone + oral doxycycline

Question 3

inpatients regimen for PID

Answer 3

IV cefoxitin or cefotetan plus oral doxycycline or parental IV clincamycin plus gentamicin

Question 4

Septic pelvic trombophlebitis - RF

Answer 4

1. cesarean
2. pelvic surgery
3. endometritis
4. PID
5. pregnancy
6. Malignancy

Question 5

Septic pelvic trombophlebitis - pathophys

Answer 5

hypercoagulability
pelvic venous dilation
vascular trauma
infection

Question 6

Septic pelvic trombophlebitis - presentation

Answer 6

1. fever unresponsive to antibiotics
2. no localised signs/symptoms
3. negative infectious evaluation
4. diagnosis of exclusion

Question 7

Septic pelvic trombophlebitis - treatment

Answer 7

anticoagulation

broad spectrum antibiotics

Question 8

Gonococcal pharyngitis

Answer 8

fever, and lower abdominal pain (associated with PID)

–> non tender cervical lymphadenopathy

Question 9

infectious genital ulcer - ddx

Answer 9

painful: HSV, H. ducreyi (chancroid)
painless: syphylis, Chlamydia trachomatis L1-L3)

Question 10

how to confirm genital HSV

Answer 10

PCR

2nd line: culture or Tzank smear

Question 11

genital hsv vs H. ducrey on presentation

Answer 11

HSV –> small vesicles or ulcers on erythematous base, Mild lymphadenopathy
ducrey –> larger, deep ulcers with gray/yellow exudare, well demarcated, SEVERE lymphadenopathy that may suppurate

Question 12

HPV infection - vaccination?

Answer 12

yes –> do the vaccine

Question 13

non pregant women with syphilis and allergy to penicillin

Answer 13

doxicycline

Question 14

staph toxic shock syndrome - risks

Answer 14

tampon use
nasal packing
surgical/postpartum wound infection

Question 15

staph toxic shock syndrome - mechanism

Answer 15

S. aureus –> exotoxin (superantigen)

Question 16

staph toxic shock syndrome - clinical features

Answer 16

• fever (39 or more)
• HYPOTENSION
• DIffuse macular rash (palms + soles)
• desquamation 1-3 wks after disease onset
• vomiting diarrhea
• altered mental status (no focal signs)

Question 17

staph toxic shock syndrome - treatment

Answer 17

supportive therapy
removal of foreign body
antibiotic (eg. clindamycin + vanco

Question 18

chlamydia and gonorr - treatment

Answer 18

empiric: azytthro + ceftriaxone
confirmed chlamy only: azythromycin
confirmed gonorh only: azith + ceftriaxone (due to increasing resistance to cephalosp)

Question 19

condylomata acuminata - etiology / prevention

Answer 19

HPV 6, 11

vaccination, barrier contraception

Question 20

condylomata acuminata - clinical features

Answer 20

multiple pink or skin-colored lesions

lesions ranigng from smooth, flattened papules to exophytic/cauliflower like growths

Question 21

condylomata acuminata - treatment

Answer 21

chemical: podophyllin resin, trichloroacetic acid
immunologic: imiquimod
surgical: cryotherapy, laser, excision

Question 22

condylomata lata - how to differentiate them from acuminata

Answer 22

lata are flat, velvety lesions –> broader base and flatter surface and are lobulated or plaque-like

Question 23

characteristics of ulcerative STD - diseases and agents

Answer 23

Chancroid - h. ducreyi
Genital herpes - HSV 1 + 2
Granuloma inguinale (donovanosis) - Klebsiella granulomatis
syphilis - Treponema pallidume
Lymphogranuloma venereum - C. trachomatis

Question 24

syphilis - features of primary lesion

Answer 24

single, indurated welll circumscribed ulcer

clean base

Question 25

Lymphogranuloma venereum - features of primary lesion

Answer 25

small shallow ulcers | large painful coalsesced inguinal lumph nodes (buboes)

Question 26

Granuloma inguinale - features of primary lesion

Answer 26

extensive + progressive ulcerative lesions without lymphadenopathy base may have granulation like tissue gram negative intracytoplasmic cysts (donovan bodies)

Question 27

chancroid - features of primary lesion

Answer 27

multiple + deep ulcers base may have gray to yellow exudate organism often clump in long parallel strands

Question 28

genital herpes - features of primary lesion

Answer 28

multiple small grouped ulcers shallow with erythematous base sms often clumg in long parallel stands

Question 29

syphilis - treponemal vs nontreponemal

Answer 29

- nontreponemal (RPR, VDRL: anti-cardiolipine, quantitive, decreased titers confirm treatment, possbile FN in early infection - Treponemal (FTA-ABS): anti-treponemal, qualitive, greater sensitivity in early, positive after treatment

Question 30

recommendations for chlamydia and neisseria screening fo women

Answer 30

anual in all sexually active women age under 25 and 25 or older with risk factors

Question 31

a risk factor for bacterial vaginosis

Answer 31

douching

Question 32

tubo-varian abscess (complication of PID) - presentation

Answer 32

fever, abd pain, COMPLEX MULTILOCULATED ADXENAL MASS WITH THICK WALLS AND INTERNAL DEBRIS ON u/s, ELEVATED LEUKOCYTOES, ELEVATED ca125 + crp