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38 Cards in this Set
- Front
- Back
What is pelvic inflammatory disease?
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STD complication only experienced by women
Infertility, Chronic Pelvic Pain, Ectopic Pregnancy |
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what is meant by mucopurulent discharge
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smelly discharge with WBCs
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An 18 y/o white women woke up in the morning to find her left knee was hot, swollen, and very painful. She could not walk to work and a friend offered her a ride to the clinic. While she was waiting and filling out a questionnaire, she realized that her right hand was stiff and it was hard to hold the pen tightly. She also remembered a burning sensation when she urinated.
A history taken by the medical student revealed that she had 3 male sexual partners during the last month, one of whom was new. She had never had a swollen joint before. However, she had a history of sexually transmitted disease (chlamydia the previous summer). Physical exam revealed a tender knee joint which yielded a purulent synovial fluid on aspiration. The fluid had 80,000 WBC’s/mm3. She had a cervical discharge that on Gram stain showed Gram-negative diplococci within the poly’s. Cultures on the synovial fluid were negative. What is she likely diagnosed with |
Neisseria gonorrhoeae
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What are the characteristics of Neisseria? (gram -/+, shape, requirement, oxidase +/-)
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Gram Negative diplococci
Coffee bean shape requires CO2 to grow Oxidase positive (aerobic) |
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if something grows on a cysteine trypticase agar what is it?
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Neisseria
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For the following, please list if they grow on nutrient agar, ferment glucose, and ferment maltose:
N. gonnorhoeae N. meningitidis Moraxella catarrhalis |
grow on nutrient agar, ferment glucose, and ferment maltose
N. gonnorhoeae: (-); (+); (-) N. meningitidis: (-); (+); (+) Moraxella catarrhalis: (+); (-); (-) |
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with respect to gonorrhoea who is more likely to have it, M/F?
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FEMALE
dirty |
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the following is the clinical presentation of what?
Purulent discharge Dysuria Frequency |
Neisseria Gonorrhoeae
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What is the major virulence factor of Neisseria Gonorrhoeae?
*** |
PILI
note: Antigenic variation of pilin types is frequent due to many silent (nonfunctional) loci that recombine with a pilin promoter |
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Describe the outer membrane proteins I,II, and III i...what disease are these associated with?
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they are virulence factors for GONORRHEA
OMP I - functions as a porin (Por) protein with OMP III → resists serum killing OMP II - opacity (Opa) protein (renders colonies less translucent) absent in strains that cause disseminated gonococcal infections OMP III – reduction-modifiable (Rm) proteins stimulate antibodies that binds IgG and interferes with intracellular killing |
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T/F
Neisseria gonorrhoeae has a capsule that plays a role in its virulence |
FALSE
NO CAPSULE |
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what leads to the creamy discharge seen in n. gonorrhoeae?
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Invade the mucous membranes (nonciliated columnar epi’s) → acute suppuration (creamy discharge)
Damage due to brisk inflammatory response → clinical symptoms of dysuria and discharge |
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T/F
Gram stain is sufficient for diagnosis of gonorrhoeae in both Males and Females |
FALSE
it is good for males but for females you need to culture |
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Tx for gonorrhoeae?
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Ceftriaxone
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A 25-year-old male, Mr. C, saw a physician with a complaint of purulent discharge from his penis. The diagnosis of gonorrhea was made and he was given ceftriaxone (3rd generation cephalosporin) by intramuscular injection. He improved initially but over the last 3 days he noticed a milder but persistent urethral discharge and pain on urination. Worried that he may not have been cured, he went to a Sexually Transmitted Disease Clinic for evaluation. He reported having no sexual intercourse since his last visit. His latest sexual partner, Ms. G, accompanied him to the clinic, although she had no complaints of pain, vaginal irritation, or discharge.
Mr. C had a small amount of clear urethral discharge. Ms. G was found to have a greenish discharge emanating from her cervical os. Her cervix was inflamed and bled easily when a swab was used to remove adherent secretions. Gram stains of both Mr. C and Ms. G revealed numerous neutrophils but no evidence of Gram-negative diplococci. What is the likely cause of this infection? |
Chlamydia
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Chlamydia can exist in 2 forms, what are they?
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Elementary body: Infectious
Reticulate body: nonifectious (growing) |
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What serotypes of chlamydia trachomatis causes classic chlamydia (including: Nongonococcal urethritis, Reiter’s syndrome, proctitis, mucopurulent cervicitis, salpingitis, neonatal conjunctivitis, infant pneumonia)
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D-K
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Pathogenesis of Chlamydia?
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Chlamydia attach to cells and become phagocytized
Avoid lysosomal fusion Change from nonreplicating elementary bodies to metabolically active reticulate bodies**** Replicate and develop into elementary bodies (infectious) Leave host cell → lysing it in process Initiate new infection |
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a pt has recently moved the middle east and presents with blindness. It appears that keratoconjunctivitis has developed and progressed to conjunctival and corneal scarring, which lead to the blindness... What was the cause of this?
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Chlamydia trachomatis A,B,or C Serotype
disease=Trachoma DOC: tetracyclines or Sulfonamides |
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10-40% of women with untreated chlamydial or gonococcal cervicitis develop what?
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pelvic inflammatory disease (PID) particularly in teens due to ectopy
15-25% of women with PID become infertile Risk of tubal pregnancy > 8X after PID Cause spontaneous abortions, stillbirths, premature delivery, low birth weight and permanently disabling infant infections |
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What is cervical ectopy? why is it important?
**** |
Ectopy also makes the cervix more susceptible to Chlamydial and gonorrheal infections as well as to HIV infections. (common in teens, will normally regress)
growth of cervical tissue into the vagina |
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Clinical features: initial symptoms may be ulcer on the genitalia → suppurative inquinal adenitis → lymphatic obstruction and rectal strictures
what does this pt have? serotype? |
pt has Lymphogranuloma venereum
due to C. trachomatis (L1, L2, and L3) other sx (from the web): Drainage through the skin from lymph nodes in groin Blood or pus from the rectum (blood in the stools) Painful bowel movements (tenesmus) Swelling of the labia |
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pt presents with a vaginal pH > 5 with the release of amine-like odor. Clue cells are present in the gram stain...what is this? species that cause it
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Bacterial Vaginosis
Gardnerella vaginals; Mobiluncus sp (curved anaerobic gram neg rod) part of normal flora, not acquired sexually, do not need to treat partner |
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Malodorous, frothy discharge associated with burning, itching and chafing.
Diffuse vaginal erythema ...what is this? cause? |
Trichomoniasis
Trichomonas vaginalis |
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sores followed by rash should make you think?
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SYPHILIS
--treponema pallidum |
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pt presents with a single painless ulcer on the genitalia....
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SYPHILIS
--treponema pallidum enter through microabrasion |
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in a man with syphilis, which is infective, the chancre or the rash?
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both!
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after the rash, what can long term untreated syphilis lead to? 3
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Gummas
CV syphilis Neural Syphilis |
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what stage of syphilis is this?
Usually a single chancre develops after ~3 weeks Chancre appears at the site where Treponema entered the body Chancre last about a month |
Primary Syphilis
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what stage of syphilis is this:
Skin rash is characteristic Skin lesions are infectious Rash will resolve with or without treatment About 1/3 will cure spontaneously |
Secondary syphilis
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what stage of syphilis is this:
Gummas develop in skin or other tissues, characterized by granuloma formation (cellular hypersensitivity reaction) |
Tertiary Syphilis
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T/F
Treponema pallidum cannot be grown in culture |
TRUE
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What anti-body will be positive in 99% of syphilis pts?
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Wasserman Ab
in RPR |
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What is the confirmatory test for syphilis?
** |
FTA-absorption test
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to diagnose neurosyphilis, what must you do?
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must do VDRL test with cerebral spinal fluid
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Tx for Syphilis?
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Pen G
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soft chancre = ?
painful or painless? |
Haemophilus ducreyi
PAINFUL bleeds easy |
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Itchy, reddish papules in the webs of the fingers, arm pits, and genital region...
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Scabies
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