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micro pharm > STDs/UTIs > Flashcards

STDs/UTIs Flashcards

1
Q

Most likely diagnosis- urinary frequency and burning with urethral discharge?

A

urethritis

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2
Q

Best initial test for urethritis

A

urethral swab for gram stain. Additional tests- urine testing for nucleic acid amplification to detect gonorrhea and chlamydia, wbc, intracellular gram negative diplococci is sufficient evidence of Neisseria gonorrhoeae

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3
Q

Most accurate test for urethritis

A

urethral culture, DNA probe, nucleic acid amplification test for N. gonorrhoeae and Chlamydia.

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4
Q

Most common causes of urethritis

A

Chlamydia, gonorrhea, Neisseria, mycoplasma genitalium, ureaplasma

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5
Q

Tx for urethritis

A

cover for gonorrhea and chlamydia
gonorrhea- cefixime, ceftriazone
chlamydia- azithromycin, doxycycline

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6
Q

Are quinolones effective for gonorrhea/chlamydia

A

No, resistant

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7
Q

Cervicitis presentation

A

cervical discharge, inflamed “strawberry” cervix

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8
Q

Causes of cervicitis

A

Chlamydia, gonorrhoeae, trichomonas vaginalis, HSV

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9
Q

Tx of cervicitis

A

Tx for Gonorrhea (Cefixime, Ceftriazone) and Chlamydia (Azithromycin and Doxycycline)

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10
Q

PID presents with

A

lower abd tenderness, lower abd pain, fever, cervical motion tenderness, leukocytosis

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11
Q

Initial test in patient with suspected PID

A

Pregnancy

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12
Q

Diagnostic test for PID

A

Cervical swab for culture, DNA probe, or nucleic acid amplification to confirm etiology.

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13
Q

Most accurate test for PID

A

Laparoscopy. Required only if diagnosis is unclear, symptoms persist despite therapy, or there are recurrent episodes for unclear reasons

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14
Q

PID tx

A

Inpatient- Cefoxitin or cefotetan with doxy

outpatient- Ceftriazone and doxy (possibly with metronidazole)

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15
Q

PID tx in pt with PCN anaphylaxis

A

outpatient- levofloxacin and metronidazole

inpatient- clindamycin and gentamicin

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16
Q

Most likely diagnosis- Painless genital ulcers

A

Syphilis

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17
Q

Most likely diagnosis- Painful genital ulcers

A

Chancroid (Haemophilus ducreyi)

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18
Q

Most likely diagnosis- Inguinal lymph nodes tender and suppurating

A

lymphogranuloma venereum

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19
Q

Most likely diagnosis- Vesicles prior to ulcer and painful

A

Herpes simplex

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20
Q

Diagnostic test for syphilis

A

Dark field microscopy (If positive for spirochetes no further testing necessary), VDRL or RPR (75% sensitive in primary syphilis), FTA or MHA-TP (confirmatory).

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21
Q

Diagnostic test for Chancroid (Haemophilus ducreyi)

A

Stain and culture on specialized media

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22
Q

Diagnostic test for Lymphogranuloma venereum

A

Complement fixation titers in blood, nucleic acid amplification testin on swab

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23
Q

Diagnostic test for Herpes simplex

A

Tzanck prep is the best initial test, viral culture is most accurate

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24
Q

Syphilis tx

A

Single dose of IM benzathine PCN, Doxy if PCN allergy

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25
Q

Chancroid (Haemophilus ducreyi) tx

A

Azithromycin (single dose)

26
Q

Lymphogranuloma venereum tx

A

Doxycycline

27
Q

Herpes simplex tx

A

Acyclovir, valacyclovir, famciclovir. Foscarnet for acyclovir resistant herpes

28
Q

A woman comes to the clinic with multiple painful genital vesicles. What is the next step in management?

a. acyclovir PO
b. acyclovir topical
c. Tzanck prep
d. viral culture
e. serology
f. PCR

A

A. If clear for herpes no testing necessary. Topical acyclovir is not helpful. Viral culture is most accurate, serology is not useful.

29
Q

Primary syphilis presentation

A

painless genital ulcer with heaped up indurated edges. (painful if secondarily infected with bacteria. Painless adenopathy.

30
Q

Secondary syphilis presentation

A

rash (palms and soles), alopecia areata, mucous patches, condylomata lata

31
Q

Tertiary syphilis presentation

A

Neurosyphilis- meningovascular (stroke from vasculitis), Tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil
aortitis- aorticregurgitation, aortic aneurysm
gummas (skin and bone lesions)

32
Q

Is PCN required for chancres to heal?

A

No, PCN prevents later stages

33
Q

Sensitivity of VDRL or RPR is best in

A

secondary (99%), then Tertiary (95%), Primary (75-85%)

34
Q

Sensitiity of FTA-ABS is best in

A

Secondary (100%), then tertiary (98%), Primary (95%)

35
Q

False positive VDRL/ABS most common in

A

infection, older age, injection drug use and AIDS, malaria, antiphopholipid syndrome, and endocarditis. Titers are reliable at greater than 1:8. Lower titer is more often falseley positive. High titers (greater than 1:32) are rearely false positive.

36
Q

Syphilis tx

A

Primary and Secondary syphilis: single IM injection of PCN. Oral Doxy if PCN allergic. Tertiary syphilis: IV PCN, Desensitizeif PCN allergic.

37
Q

Jarisch-Herxheimer reaction

A

Fever and worse symptoms after tx, give asa and antipyretics; it will pass

38
Q

Condylomata Acuminata cause

A

papillomavirus

39
Q

Condylomata acuminata dx

A

visual appearance. Wrong answers include biopsy, serology, stain, smear and culture.

40
Q

Condylomata acuminata tx

A

Remove via physical means such as cryotherapy with liquid nitrogen, surgery for large ones, laser, or melting them with podophyllin or trichloroacetic acid. Imiquimod is a locally applied immunostimulant that leads to the sloughing off of the lesion.

41
Q

Found on hair earing areas (axilla, pubis), causes itching, visibleon the surface

A

Pediculosis (crabs)

42
Q

Pediculosis tx

A

Permethrin; lindane is equal in efficacy but more toxic

43
Q

Found in web spaces between fingers and toes or at elbows,found around the nipples or near the genitals, burrows visible, but smaller than pediculosis

A

Scabies

44
Q

Scabies dx

A

Scrape and magnify

45
Q

Scabies tx

A

Tx with permethrin. Widespread disease responds to ivermectin; severe disease needs repeat dosing

46
Q

UTI PEARLS

A

present with dysuria and fever
UA shows increased WBCs
E.coli is most common.
Quinolones are the best initial therapy

47
Q

Anatomic defects that lead to UTIs

A

Stones, strictures, tumor or prostate hypertrophy, diabetes. Any form form of obstruction of or foreign body in the urinary system. Foley catheter is a foreign body. Neurogenic bladders is an obstruction.

48
Q

Frequency vs polyuria

A

Frequency means multiple episodes of micturation. Polyuria is an increase in the volume of urine.

49
Q

Cystitis presents with dysuria and

A

Suprapubic pain/ discomfort, mild or absent fever

50
Q

Cystitis best initial test

A

UA with >10WBCs

51
Q

Cystitis most accurate test

A

urine culture

52
Q

Cystitis tx

A

TMP/SMZ if local resistance low
Cipro
Cephalexin (all beta-lactams considered safe in pregnancy)
Nitrofurantoin, especially in pregnant patients

53
Q

A 36yo generally healthy woman comes to the office with urinary frequency and burning. The UA shows more than 50 WBCs per high power field. What is the most appropriate next step in management?

a. TMP/SMZ for 3days
b. TMP/SMZ for 7days
c. Urine culture
d. US of urinary system
e. CTscan of urinary system

A

A. culture and imaging only required if there are frequent episodes of cystitis or failure to respond to therapy. Three days is sufficient for uncomplicated cystitis. . Seven days required if there is an anatomic abnormality.

54
Q

Pyelonephritis presents with

A

dysuria, flank or CVA tenderness, high fever, occasionally with abd pain from an inflamed kidney. US shows increased WBCs. Imaging studies are not done

55
Q

Pyelonephritis tx

A

Any drug for for gram- negative bacilli would be effective. Ampicillin and gentamicin until culture results known. Cipro

56
Q

Acute prostatitis presents with

A

dysuria with perineal pain, tender prostate on exam

57
Q

Acute prostatitis dx

A

Urine culture, greatly increased diagnostic yield with prostate massage.

58
Q

Acute Prostatitis tx

A

Ampicillin and gentamicin until cultures. Cipro

59
Q

Chronic prostatitis tx

A

TMP/SMZ for 6-8wks

60
Q

Pyelonephritis that does not resolve with appropriate therapy

A

Perinephric abscess

61
Q

Perinephric abscess dx and tx

A

US or CT imaging when pyelonephritis is associated with persistent fever after 5-7d. Drainage of the fluid collection is mandatory with culture of the infected fluid.

micro pharm (6 decks)

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