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39 Cards in this Set

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what bacteria maintains acidic environment?
lactic acid producing lactobacilli
T or F
change in vaginal envir by meds, sex, illness can lead to overgrowth of other bacteria & infection (vaginitis)
T
T or F
vaginitis can be cz by bacteria, fungal or protozoal (list examples)
T
bacterial: polybacterial, Gardnerella
fungal: Candida
protozoa: Trichomonas
Vaginitis (bacterial, Trich, Candida) may present with sx;
inc vaginal d/c*
vulvovaginal pruritus*, w/ w/o burning sensation or odor
DDx
UTI, STD, normal phy secretion, malig (d/c w/ cervical ca)
which vaginitis infection inc risk of PID
bacterial vaginosis
if vaginitis occurs during preg, what does it inc the risk of?
preterm labor or
preterm rupture of memb
Trich main sx
profuse, smelly yellow-green FROTHY discharge
Yeast main sx
pruritus
(so PE shows excoriated, erythema vulva)
BV d/c
homogenous, gray-wh fishy odor (whiff test on KOH)
if test pt's vaginal pH w/ nitrazine paper, which cz of vaginitis will show up basic
BV, Trich >4.5
What do you see on saline for BV, Trich, Yeast?
1. BV: Clue cells (epi cells coat w/ bacteria)
2. Trich: motile trichomonads
3. Yeast: nothing!
What do you see on KOH for BV, Trich, Yeast?
1. BV--whiff test (fishy)
2. Trich--nothing
3. YEAST! PSEUDOHYPHAE
how tx bv, trich, yeast
1. bv: metro
2. tri: metro, std! tx partner
3. yeast: topical antifungal or po fluconazole
while you worry about vaginitis (bv, trich, yeast), also need to test for which 2 organisms in cervicitis?
Neisseria gonorrhoeae
Chlamydia trachomatis
most common bacterial STD in US
chylamydia trachomatis
if tx for chylamydia trachomatis, also tx for what std?
neisseria gonorrhoeae
chylamydia often asx, but if sx, what?
urethritis (dysuria, freq)
mucopurulent cervicitis (vag d/c, bl, dysparenunia)
salpingitis
PID (abd pain, fever)
how tx chylamdia
doxycycline*
or azithromycin
if preg: erythromycin
Sx of gonorrhea for men and women
women: green-yellow d/c, pain in pelvis/adnexa
men: purulent urethral dc
PID is a variety of acute, subacute, chronic infections of the ascending genital tract, incl...(5)
endometrium (endometritis)*
uterine wall (myometritis)*
oviducts (salpingitis)*
ovary (oophoritis)*
parietal peritoneum (peritonitis)*
RF for PID
early sex
mult partner
unprotected or freq intercourse
mucopurulent cervicitis (chy)
prior PID
IUD use
what 2 lowers risk of PID
OCP, barrier contraceptive
Sx of PID
1-3d lower abd pain* w/ w/o f/n/v
hx of recent menses
abn cervical or vaginal dc
PE of PID
Tenderness: uni or bi lower abd, uterine, adnex, cervical
+/or
purulent cervical discharge
DDx of PID
appy, diverticulitis, UTI/pyelo, ulcer colitis, regional ileitis
ectopic, endometriosis, adnexal torsion, ovarian tumor or hemorrhagic cyst
Dx of PID
lower abd pain, adnexal, AND cervical motion tenderness**
supportive but not dx of PID
f >38C
inc ESR, CRP
WBC >10
+G,C
U/S: pelvic abscess
Definitive dx, use what tool, and what will you see?
laparoscopy
pus in peritoneal cavity
what do you always check in women with abd pains?
b-hCG for preg
If PID, also run what other bl tests?
VDRL/RPR, HIV, LFT (fitz-hugh-curtis)
Tx of PID should target common pathogens ie gon, chy, anaerobes
INPT IV ABX: cefoxitin (or cefotetan) AND doxy, OR clinda and gent until pt asx for 48hrs; follow doxy po 14d

OUTPT ABX: ceftriaxone+doxy OR ofloxacin+clinda/metro 14d
Situations where hospitalize pt:
1. pelvic/tubo-ovarian abscess (TOA)
2. peritonitis
3. non-compliance
4. n/emesis prev PO meds
5. hi f
6. hi wbc
7. teenage
8. nulliparous
9. pts not improve after 48-72 hr of outpt tx
when to suspect pt w/ TOA
sev pain
hi f
n/v
signs of sepsis
peritoneal signs
adnexal mass
tx of toa
hospitalize for IV abx, hydration (n/v), possible surgery (drain/tahbso)
complications of PID
toa*, ectopic*, infertility*, chronic pelvic pain, fitz-hugh-curtis (5-10%)
Toxic Shock Syndrome cz by what toxin (not organism)
preformed Staph Aureus toxin (TSST-1)
Sx of TSS
*f, *diffuse sun-burn rash
diarrhea, vomit, sore throat, HA, myalgia
could rapid progress to HYPOTENSIVE SHOCK
DESQUAMATION-PALMS, SOLES 1-2WKS
Tx of Toxic shock syndrome
hospitalize, fluids, pressors, transfusion, ventilation prn
IV anti-staph abx (nafcillin, oxacillin)
steriods dec sx severity