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Boards - Infection 1
OBGYN Qualifying exam
213
Other
Post-Graduate
06/27/2020

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Cards

Term
#1 STI
Definition
HSV
Term
#1 genital ulcer
Definition
cancheroid
Term
risk of fetal transmission in primary HSV outbreak
Definition
30-60%
Term
risk of fetal transmission in recurrent HSV outbreak
Definition
3%
Term
risk of HSV transmission to baby if had no outbreak (not delivery, 1T)
Definition
1-2%
Term
prevalence of HSV1, 2, both
Definition
1 - 60%, 2- 22%, both 13%
Term
race with most HSV
Definition
whites 40%
Term
% of NEW cases of genital HSV that are HSV1
Definition
50%
Term
which HSV sheds more
Definition
2
Term
how often do HSV 1 and 2 on average have outbreaks
Definition
1 - 1/y
2 - 4/y
Term
how long does it take for HSV Ab to be positive
Definition
1-2wk IgM, 12wk IgG
Term
sens/spec of HSV diagnostic tests
Definition
culture 5-30% false negative, PCT #1 for CNS otherwise bad, cytology worst, Ab 90% sens 97% spec
Term
when to do HSV antibodies on someone - 6
Definition
recurrence despite medication, atypical symptoms with negative culture, non-primary 1st episode, HSV in partner to rule out existing HSV, request of STI screen, MSM routine STI screen
Term
signs of a primary HSV episode (other than lesions)- 5
Definition
85% asymptomatic, 80% lymphadenopathy, 67% fever/myalgias, urinary retention, meningitis
Term
highest time of HSV shedding - 3
Definition
during the 10-12d of a primary episode before crusting > during a recurrent episode for 4d before crusting > the entire 1st year after exposure
Term
when must medication be started during prodrome for it to be useful in HSV
Definition
prodrome is 12-24h, meds need to be within 24h of prodrome
Term
fetal syndrome with HSV in 1T - 3
Definition
chorioretinitis, microcephaly, skin lesions
Term
who do you give HSV suppression to - 5
Definition
36wk gestation, recurrent, request, immune compromised, unaffected partner
Term
acyclovir dosing - initial, recurrent, prevention
Definition
initial - 400mg TID 7-10d, recurrent - 400mg TID 5d, prevention - 400mg BID
Term
valcyclovir dosing - initial, recurrent, prevention
Definition
initial - 1g BID 7-10d, recurrent 500mg BID 3d, prevention - 500mg QD to BID
Term
antivirals reduce HSV transmission __%, reduce shedding from __ to __% of days a month, and reduce recurrent episodes by __%
Definition
antivirals reduce HSV transmission 50%, reduce shedding from 11 to 3% of days a month, and reduce recurrent episodes by 80%
Term
without suppression affected babies by HSV after delivery have what prognosis
Definition
50% die, 50% have permanent neurological sequalae
Term
HSV suppression after 36wk reduces CD by
Definition
40%
Term
which genital lesions are associated with co-infection with HIV - 3
Definition
canceroid, granuloma inguinalae, potentially syphillis im unclear
Term
which co-infections are associated with syphillis - 2
Definition
potentially HIV im not sure, def canceroid
Term
cancheroid - bug, metabolism, and sign on staining
Definition
hemophilus ducrei, facultative aneroba, school of fish
Term
locations of cancheroid transmission - 3
Definition
asia, Africa, carribean
Term
cancheroid, lymphogranuloma venerium, granuloma inguinalae - lesion progression
Definition
C - papule > pustule > ulcer (halo, necrotic exudate) / LV - vesicle > papule > ulcer / GI - nodule > papule > ulcer (velvety, bleeds, beefy)
Term
cancheroid, lymphogranuloma venerium, granuloma inguinalae - pain
Definition
C - painful, LV/GI - painless
Term
cancheroid, lymphogranuloma venerium, granuloma inguinalae - lymphnode involvement
Definition
C - inguinal/suppurlative 50% / LV - inguinal/anogenital/groove 20% / GI - pseudobubo (subcutaneous granuloma)
Term
cancheroid, lymphogranuloma venerium, granuloma inguinalae - treatment
Definition
C - azithro 1g / LV - doxy 100mg BID 21d / GI - azithro 1g x3w
Term
cancheroid, lymphogranuloma venerium, granuloma inguinalae - how far back do you have to treat sexual contacts for
Definition
C - 7d / LV - 30d / GI - 60d
Term
lymphogranuloma venerium - bug
Definition
chlamydia trachomatis 11, 12, 13
Term
lymphogranuloma venerium - where to get it 3
Definition
Africa, s. America, asia
Term
lymphogranuloma venerium - incidence
Definition
300/y in USA
Term
lymphogranuloma venerium - additional sx to lesion and inguinal - 3
Definition
cervicitis, urethritis, adenitis
Term
lymphogranuloma venerium - alternative treatments
Definition
erythromycin - important because cant use doxy in pregnancy
Term
granuloma inguinalae - incidence
Definition
100/y in USA
Term
granuloma inguinalae - where to get it - 5
Definition
carribean, India, Australia, S Africa, new guenie
Term
granuloma inguinalae - bug, gram stain signs
Definition
intracellylar gram negative klebsiella granulomatous, Donovan bodies on gimesa stain
Term
granuloma inguinalae - diagnosis
Definition
gimesa stain only, Donovan bodies
Term
lymphogranuloma venerium - diagnosis
Definition
NAAT is not FDA approved, + serology is helpful
Term
granuloma inguinalae - symptoms other than lesion and lymphadenopathy
Definition
extra genital infection can occur in mouth, bone, pelvis
Term
granuloma inguinalae - alternative treatments - 4
Definition
doxycycline, cipro, erythro, bactrim
Term
granuloma inguinalae - what do you do if treatment isn't working
Definition
in 1-2d if not working do gentamicin IV 1mg/kg q8h
Term
highest age group with syphillis
Definition
18-24yo females 15%
Term
who should be screened for syphillis - 9
Definition
MSM, HIV, on PREP, partner has it, incancerated, prostitute, males <29yo, locally high rates, pregnancy
Term
most definitive way to diagnose syphillis
Definition
dark filed microscopy
Term
way to screen for and monitor syphillis
Definition
non-treponemal RPR, VDRL
Term
ways to diagnose syphillis
Definition
treponemal - FTA-ABS / TP-PA, dark field microscopy
Term
when are syphillis screening tests positive
Definition
in 4-6wk
Term
when are syphillis screening tests false positive - 10
Definition
rheumatic disease, infection, cancer, liver disease, IV drugs, pregnancy, SLE, HIV, malaria, small pox vaccine
Term
which tests for syphillis turn negative after treatment
Definition
the non-treponemal RPR/VDRL
Term
what is the transmission rate for 1 and multiple exposures to syphilis
Definition
1 - 10%, multiple 70%
Term
fetal complications of syphillis infection in utero - 4
Definition
stillbirth, SAB, PTL, congenital infection
Term
how do you decrease the risk of stillbirth in syphilis
Definition
avoid delivery within 30d of treatment of primary and secondary syphilis
Term
fetal US signs of congenital syphilis - 4
Definition
placentomeagly, IUGR, HSM, hydrops, poly
Term
signs of placetomeagly - 4
Definition
large, thick, pale, few villi, necrotizing fasciitis
Term
early fetal signs of congenital syphillis - 9
Definition
maculopapular rash, snuffles, jaundice, pneumonia, osteochondritis, iritis, HSM, thrombocytopenia, adenopathy
Term
late fetal signs of congenital syphillis - 11
Definition
hutchinsons teeth, mulberry molars, interstitial keratitis, deafness, saddle nose, saber shins, MR, paresis, hydrocephalus, clutton joints, optic nerve atrophy
Term
incidence of jarsich-herxheimer reaction in syphillis treatment
Definition
45-95%
Term
when does a jarsich-herxheimer reaction in syphillis treatment
Definition
2-24h
Term
jarsich-herxheimer reaction in syphillis treatment
Definition
antipyretics
Term
timing of the stages of syphillis
Definition
primary - 3-6wk
secondary - 6wk-6mo
early latent - <1y
late latent - >1y
tertiary - n/a
neuro - n/a
Term
which stages of syphillis are infectious
Definition
primary, secondary, potentially early latent
Term
fetal transmission rates in each stage of syphillis
Definition
primary - 40-80%
secondary - 40-80%
early latent - 40-50%
late latent - <10%
tertiary - <10%
CNS - depends on stage corresponding
Term
signs of primary syphillis - 2
Definition
painless cancher, painless lymphadenopathy
Term
signs of secondary syphillis - 8
Definition
maculopapular rash 90% (rough, red-brown, palms, soles), condyloma lata 15% (painless mucosal), lymphadenopathy 70%, fever, sore throat, headache, weight loss, hair loss
Term
signs of tertiary syphillis - 6
Definition
gumma 50% (soft tissue growth), cardiac 25% (endocarditis, aneurysm, aortic insufficiency), tabeius dorsalis 25%, argyle Robertson pupil 25%
Term
signs of argyle Robertson pupil
Definition
can accommodate but can not react
Term
3 types of neurosyphillis
Definition
meningeal (acute, chronic), porchematous, granulomatous
Term
signs of porchematous neurosyphilis - 6
Definition
pain, parasthesias, decreased DTRs, ataxia, tabeis dorsalis, argyle Robertson pupil
Term
treatment of primary and secondary syphilis and early latent
Definition
benzathine pcn g 2.4 mil U IM x1
Term
treatment of late latent and tertiary syphillis
Definition
benzathine pcn g 2.4 mil U IM x3 over 3 weeks
Term
treatment of neurosyphillis
Definition
aqueous crystalline PCN G 18-24 million units (3-4 mil U q4h IV x10-14d)
Term
when in syphillis should you do a LP - 3
Definition
opthamologic symptoms, CNS symptoms, tertiary syphillis
Term
how far back do you need to test partners for syphillis
Definition
primary - 3mo, secondary - 6mo, early latent - 12mo
Term
how do titers guide syphilis treatment
Definition
primary and secondary - should drop 4x in 6mo and 8x in 12mo / early latent should drop 4x in 12mo ----- if not then get HIV testing, retreat, and do LP
Term
#1 bacterial STI
Definition
chlamydia
Term
most commonage group chlamydia
Definition
20-25yo
Term
chance of getting chlamydia in 1 encounter
Definition
40%
Term
fetal chlamydia signs - 2
Definition
conjunctivitis, pneumonia
Term
screening for chlamydia
Definition
sexually active <25yo, pregnancy at NOB and 3T if <25yo
Term
best diagnosis for chlamydia
Definition
NAAT >95% s/s, self swab = cervical swab, urine is 10% less s/s
Term
treatment chlamydia
Definition
azithromycin 1g PO
Term
alternative treatments chlamydia - 4
Definition
doxy, erythrom, levofloxacin, ofloaxcin
Term
how far back should you give expedited treatment to partners in chlamydia
Definition
60d
Term
how long should someone with chlamydia abstain after treatment
Definition
7d
Term
indications for TOC chlamydia - 3 and timing
Definition
pregnancy, concern for compliance, persistent symptoms, earliest 3wk but usually 3mo, do test of re-infection in 3mo on everyone
Term
likelihood of re-infection of chlamydia in next 12mo
Definition
14-26%
Term
#2 most common STI in the world
Definition
gonorrhea
Term
percent co-infection gonorrhea and chlamydia
Definition
30-50%
Term
percent of PID with positive gonorrhea
Definition
25-50%
Term
who transfers gonorrhea to who
Definition
female to male 25%, male to female 50-90%
Term
diagnosis of gonorrhea
Definition
NAAT 95% S/S same for urine, self, cervix, culture 65-85% sens 100% specific, DNA probe 99% s/s, gram stain 65%
Term
which STI is most likely to affect the bartholins/skenes
Definition
gonorrhea
Term
percent of gonorrhea asymptomatic
Definition
50%
Term
percent of chlamydia asymptomatic
Definition
50%
Term
percent of gonorrhea that progresses to PID untreated
Definition
40%
Term
treatment for gonorrhea
Definition
ceftriaxone 250mg IM + azithromycin 1g PO
Term
alternative treatment gonorrhea
Definition
cefixipime and azithromycin
Term
how far back should you do expedited partner treatment for gonorrhea
Definition
60d
Term
when do you retest for gonorrhea
Definition
no TOC unless sx, do test for re-infection in 3mo
Term
signs of disseminated gonorrhea - 6
Definition
skin lesions, peripherial asymmetric arthralgia, septic arthritis, perihepatitis, endocarditis, meningitis
Term
treatment of disseminated gonorrhea
Definition
cefoxitin 1g IV q24h (q12h if meningitis or endocarditis)
Term
#1 non-viral or bacterial STI in the US
Definition
trichomonas
Term
what percent of all vaginitis is trich
Definition
25%
Term
diagnosis of trich - 4
Definition
NAAT 95-100% s/s, culture 95% s/s, wet prep 50-70%, pap 99%s 60% spec
Term
percent of trich that is asymptomatic
Definition
40%
Term
treatment of trich
Definition
metronidazole 2g x1
Term
treatment of resistant trich
Definition
continue metronidazole for 7d or can do tinidazole instead, do susceptibility testing
Term
when is TOC for trich
Definition
3mo may perform NAAT as early as 3wk
Term
cause of pubic lice
Definition
pediculous pubis
Term
treatment of pubic lice and scabies
Definition
premetherin 1% for 10 min, malathion, ivermectin, lindane (not safe in pregnancy)
Term
how long does the scabies rash last
Definition
2wk
Term
what is the name for scabies bug
Definition
sacrophitus scabesi
Term
what is the rate of PID
Definition
self reported in 4.4% of sexually active women
Term
what percent of PID were positive for gonorrhea and or chlamydia
Definition
10-20%
Term
bugs that cause PID - 6
Definition
mycoplasma, ureaplasma, gardinerella, H. flu, bacteroides, E. coli
Term
most common age group for PID
Definition
15-25yo
Term
definitive diagnosis of PID - 3
Definition
endometritis on EMBx, TVUS/MRI with hydro or TOA, LSC with fitz hugh Curtis 10% or adhesions
Term
CDC diagnostic criteria for PID
Definition
uterine/adenexa/CMT tenderness + pelvic pain + sexually active = PID unless proven otherwise
Term
supportive CDC criteria for PID diagnosis - 6
Definition
>101F, discharge, WBC in vaginal fluid, elevated ESR or CRP, G/C infection
Term
rate of infertility in PID after 1, 2, 3+ episodes
Definition
1 - 10%, 2 - 20%, 3 - 40%
Term
treatment PID outpatient
Definition
ceftriaxone 250mg IM + doxy 100mg BID +/- metronidazole 500mg x14d
Term
alternative outpatient treatment for PID
Definition
cefoxitin + probenecid + doxy +/- metronidazole
Term
treatment for PID outpatient in PCN allergy
Definition
must test for gonorrhea resistance/susceptibility, levofloxacin + metronidazole
Term
when do you have the patient come back after dx and outpatient tx of PID
Definition
48-72h and 4-6wk
Term
inpatient treatment for PID
Definition
cefotetan 2g IV q12h + doxy 2g IV q6h
Term
alternative inpatient treatment for PID
Definition
cefoxitin 2g IV q6h + doxy 100mg PO/IV q12h
Term
PID inpatient treatment in PCN allergy
Definition
clinda + gent, amp or sulbactam + doxy
Term
what to do with IUD in PID
Definition
leave it unless not improving
Term
hospitalization criteria PID - 7
Definition
surgical emergency cannot be excluded, TOA, pregnancy, PO intolerance, high fever, not responding to outpatient therapy, HIV with low CD4
Term
what increases the risk of tubal infertility in PIT
Definition
not treating within 72h
Term
when do you send a TOA for ID draining
Definition
symptoms don't improve in 3-4d of IV antibiotics
Term
when do you do a surgery for a TOA - 5
Definition
sepsis, >10cm, unstable, ruptured, PMP
Term
_% of TOA that will respond to abx at <__cm, __% of TOA that will respond to abx at >__cm
Definition
85% will respond <4cm, 40% will respond >10cm
Term
#1 risk factor for endometritis
Definition
c-section
Term
treatment of acute endometritis
Definition
ceftriaxone 250mg IM + doxy 100mg BID x14d +/- metronidazole 500mg BID x14d
Term
treatment of chronic endometritis
Definition
doxy 100mg BID x14d
Term
prevalence of BV
Definition
25% of patients, 50% of vaginal discharge
Term
bugs causing BV - 8
Definition
gardnerella, peptostreptococcus, prevotella, mobiluncus, bacteroides, fusobacterium, atopobium vaginae, mycoplasma hominis
Term
who should get screened for BV if asymptomatic
Definition
history of PTD at 24-28wk
Term
pH of BV, trich, yeast
Definition
BV >4.5, trich >4.5, yeast <4.5
Term
define chronic BV
Definition
>3 documented episodes in 12mo
Term
nugent score
Definition
gram staining of vaginal discharge for BV, gold standard
Term
amsels criteria - 4
Definition
vaginal discharge, pH >4.5, fishy odor, >20% clue cells
Term
treatment of BV
Definition
metronidazole 250mg TID x7d
Term
alternative treatments for BV - 2
Definition
clinidamycin 300mg BID x7d, scenidazole sing 2g oral ganules
Term
SE of scenidazole - 3
Definition
yeast infection, nausea, headache
Term
% of BV treatmet that will result in vaginal candidia
Definition
20%
Term
complications of BV in pregnancy - 3
Definition
PPROM, PTD, IAI
Term
complicated vaginal yeast criteria -
Definition
recurrent (4+/y), severe symptoms, suspected not albicans, diabetes, immune suppression, pregnancy
Term
indications for a fungal culture - 3
Definition
recurrent infection, possible no albicans, si/sx without a positive microscopy
Term
s/s of microscopy for yeast
Definition
50% with KOH
Term
transmission of HIV no meds - CD/SVD
Definition
SVD 20%, emergent CD 19%, planned CD 7%
Term
transmission of HIV on meds - CD/SVD
Definition
SVD 4%, emergent CD 10%, planned CD 2%
Term
HIV transmission percutaneous
Definition
0.3%
Term
HIV transmission mucomembraneous
Definition
0.03%
Term
all comers HIV sreening guidelines
Definition
13-64yo once in lifetime
Term
candidates for annual HIV screening - 5
Definition
IV drug users, prostitutes, partner with HIV, MSM, >1 partner since last test
Term
screening for HIV in pregnancy
Definition
at NOB, in 3T if high risk
Term
candidates for 3T HIV testing - 6
Definition
population risk >1:1000, symptoms, STI in past 12mo, IV drug user, new partner, >1 partner
Term
when is the window period for HIV
Definition
before 4-8wk post infection
Term
timeline of HIV infection
Definition
initial 3-6wk, acute HIV syndrome 1w-3m, HIV immune response 1-2wk, HIV latency 10y, AIDS 2y, death
Term
percent of HIV that get acute HIV syndrome
Definition
70%
Term
signs of acute HIV syndrome clinical - 7
Definition
fever, sunburn rash, myalgia, HA, sore throat, diarrhea, adenopathy
Term
lab changes in acute HIV syndrome
Definition
initial increase then decrease in T4
Term
infections associated with CD4 <400 - 5
Definition
candidia, oral hairy leukoplakia, shingles, HSV, listeria
Term
infections associated with CD4 <200 - 7
Definition
PCP, kaposki sarcoma, coccidiomyosis, cryptosporidiosis, CMV, brain toxo, HIV encephalopathy
Term
infections associated with CD4 <50 - 6
Definition
MAC, histoplasmosis, CMV retinitis, leukoencephalopathy, HIV dementia
Term
labs to get at NOB in HIV - 13
Definition
CD4, HIV RNA, CBC, LFTs, Cr, hep B, CMV, toxo, PPD, VDRL, G/C, pap, partner STI testing
Term
how often to get CD4/HIV RNA in pregnancy
Definition
q3-6mo, always 1mo after treatment change/start
Term
vaccines to make sure has in HIV/pregnancy - 4
Definition
pneumo, flu, hepatitis B, H. flu B
Term
components of HAART - 3
Definition
neucloside reverse transcriptase inhibitor - zidovudine, non-neucloside reverse transcriptase inhibitor - nevirapine, protease inhibitor - ritonavir
Term
components of PREP
Definition
tenofovir and embricitabine
Term
how many days can you give of prep at a time
Definition
90
Term
pre-eval for prep - 3
Definition
HIV Ab, STI screen, hep B screen
Term
indications for prep - 9
Definition
know HIV partner or sex in high HIV social network PLUS ONE - inconsistent condoms, STI positive, prostitution, IV drugs, alcohol dependence, incarceration, unknown HIV partner status
Term
monitoring involved in prep - 3
Definition
HIV q3mo, assess risk q2-3mo, STI questions and testing as indicated
Term
what can make prep work better and how much - 2
Definition
condoms 80% reduction combined, low viral load 96% reduction combined
Term
what can make prep work worse
Definition
spermicide with nonoxynol-9 increases HIV transmission
Term
when to DC prep - 2
Definition
patient request, positive HIV
Term
how long do you need to be on prep before anal and vaginal intercourse or sharing IV drugs
Definition
receptive anal 7d, insertive anal 20d, vaginal 20d, IV drugs 20d
Term
what is the average and possible prep efficacy
Definition
average 62%, possible 92-99%
Term
with is the efficacy of pep
Definition
81%
Term
what are the components of pep
Definition
trnofovir, embticidibine, raltigravir
Term
how long is pep
Definition
28d
Term
how long should someone on pep abstain
Definition
6-12wk
Term
pre-labs for pep - 3
Definition
CBC, LFT, Cr
Term
SE pep - 7
Definition
nausea, vomiting, diarrhea, headache, hepatitis, hyperglycemia, pancytopenia
Term
what is the high risk pep
Definition
zidovudine, lamivudine, lopinovir-ritonivir
Term
who gets high risk pep
Definition
large bore IV or large blood volume exposure
Term
candidates for pep - 10
Definition
partner with HIV, sex with high prevalence population, inconsistent condom use, STI, MSM, sex workers, IV drugs, etoh dependence, incarcerated, anal sex without condoms
Term
when is pep given after an assault
Definition
<72h - if know HIV assailent, consider if HIV unknown
>72h - not recommended
Term
pregnancy management - HIV pos, no meds, no labs
Definition
CD 38wk, 3 part SVD, baby ZVD - consider SVD only if ruptured and laboring
Term
pregnancy management - HIV pos, on meds, RNA >1000
Definition
CD 38wk, IV zvd 3h pre-op, zvd for baby
Term
pregnancy management - HIV pos, on meds, RNA <1000
Definition
SVD 39wk, ZVD for mom and baby, no FSE
Term
% with HIV that don't know it
Definition
20%
Term
percent HIV AA
Definition
66%
Term
% HIV diagnosed in pregnancy
Definition
40%
Term
% HIV from heterosexual contact
Definition
74%
Term
teratogen dolutegravir
Definition
ONTD potential
Term
teratogen stauvidine
Definition
toxic
Term
teratogen didanosine
Definition
toxic
Term
teratogen efavirenz
Definition
<8wk ONTD
Term
teratogen stavuidine with didanosine
Definition
lactic acidosis in mom
Term
teratogen indinavir
Definition
GDM risk
Term
teratogen ritonavir
Definition
GDM risk
Term
condoms reduce HIV transmission %
Definition
70%
Term
transmission of HIV with breastfeeding
Definition
15%
Term
% cancer patients with HIV
Definition
7%
Term
considerations for those on antiretrovirals and HRT
Definition
may need higher HRT levels, fosamprenavir levels can be lowered when on HRT
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