STD/kidney/endocarditis/HIV Flashcards
(30 cards)
Best initial test for urethritis, most accurate?
Urethral swab
Urethral culture/NAAT
Tx is ceftriaxone/azithromycin
Cervicitis
Dx’d with NAAT
TX’d with ceftriaxone/azithromycin
What is the first step in a woman with cervical motion tenderness, fever, leukocytosis, and lower abdominal pain?
Rule out pregnancy. This presentation is pelvic inflammatory disease, but you must rule out ectopic pregnancy
How can you tell urethritis from cystitis?
Cystitis does not give urethral discharge
What is the most accurate test for pelvic inflammatory disease?
Laparoscopy, although it is usually diagnosed clinically.
How do you treat PID? Give inpatient and outpatient
Inpatient: cefoxitin or cefotetan (anaerobic) + doxy
Outpatient: ceftriaxone and doxy
How do you diagnose syphilis?
Dark field microscopy, RPR or VDRL
What are the best initial and most accurate test for herpes Symplex
Tzank prep: best initial
Viral culture: most accurate
What is Argyll Robertson pupil
Finding of neurosyphilis. Accommodates, but does not react to light
What is the most sensitive test for neurosyphilis in the cerebrospinal fluid?
FTA (free treponemal antibody) is nearly 100% sensitive
What’s the difference in treatment between tertiary syphilis and primary or secondary syphilis?
IV PCN for tertiary
IM for the other two
Give doxy if PCN allergic
What is the Jarisch-Herxheimer reaction?
Transient fever and worsening of symptoms after treating syphillis
Will spontaneously pass, give antipyretics
How do you treat neurosyphilis in pregnant women
Desensitization therapy
How do you treat genital warts
Cryotherapy and Iniquimod
How do you treat crabs
With permethin same as scabies
What are the best initial and most accurate test for a urinary tract infection?
Best initial: urinalysis with more than 10 white blood cells
Most accurate: urine culture
How do you treat urinary tract infection
Nitrofurantoin (3 days if no anatomic abnormality)
Tmp/smx
What is the best initial therapy for pyelonephritis?
Floroquinolones
What is the main difference between treating prostatitis and cystitis?
Duration of therapy. Short for cystitis, long for prostatitis
What is the next step in treating a pyelonephritis that does not resolve with appropriate therapy?
Drainage of the perinephric abscess and culture of the fluid
What is always the most likely diagnosis with fever and a heart murmur?
Endocarditis. Confirm with echo and blood cx
Name the findings of endocarditis
Fever, murmur, janeway lesions, splinter hemorrhages, roth spots, osler nodes, septic lung emboli
What should somebody who has a Clostridium septicum endocarditis get next?
Colonoscopy. This bug is associated with diverticuli and colon cancer (like strep bovis)
How to diagnose endocarditis with negative cultures?
Oscillating vegetation on echo or:
fever greater than 100.3+ high-risk patient + signs of embolus
