CMN 572 Final Exam With
Correct Answers
chlamydia - ANSWER gold standard of testing is CX
NAAT can be used to also test for gonorrhea
treatment: azithromycin 1 g PO once (doxy if PCN allergy); azithromycin is
OK with pregnancy
gonorrhea - ANSWER NAAT, cx, or gram stain for testing
treatment: 250 mg ceftriaxone IM once PLUS azithromycin 1 g PO once
gonorrhea and chlamydia often occur together
gonorrhea is resistant to fluoroquinolones- treat with cephalosporins ONLY
syphilis - ANSWER requires 2 test for diagnosis
nontreponemal test: not specific for t.pallidum, seropositive (rx for life);
VDRL, RPR
treponemal: specific for t. pallidum antibodies; usually reactive for life
treatment: PCN G
primary: painless ulcer/chancre; perform nontreponemal test and treat with
PCN G 2.4 million units while awaiting results; if + confirm with treponemal
secondary: rash to palms/soles; all tests + and titers are highest
latent: asx with + tests
,HPV - ANSWER cytology is used to detect cervical dysplasia and provide
indirect evidence to HPV
cotest with Pap and HPV if >30 yrs or >25 yrs with ASC-US
can dx if genital warts obvious
patient applied tx: podofilox, imiquimod, sinecathechins; do NOT use with
pregnancy
provider administered tx: cryotherapy, trichloracetic acid, bichloracetic acid,
surgical excision
warts are more friable and proliferative during pregnancy
presence of warts is NOT an indication for c section
herpes - ANSWER culture is gold standard for testing
polymerase chain reaction is used to test spinal fluid
antiviral medications are used to control sx- will not eradicate virus, and does
not effect risk/freq/severity of outbreaks when DC'd
acyclovir 400 mg TID or 200 mg 5x/day
1st episode: 7-10 days of treatment
recurrent episode: 2-5 days of treatment
suppression therapy: daily
treatment may be extended if healing is not complete
bacterial vaginosis - ANSWER overgrowth of bacteria due to changes in
normal vaginal bacterial flora
always treat pregnant women with BV, it can cause pre-term labor
,metronidazole or clindamycin
goal is to re-establish normal vaginal pH or lactobacillis
PID - ANSWER usually caused by STD (gonorrhea or chlamydia)
treatment MUST cover gonorrhea, chlamydia, anaerobes, gram - bacteria,
and strep
ROCEPHIN, AZITHROMYCIN, METRONIDAZOLE
treat partners within 60 days of sx onset
IUD insertion and STDs - ANSWER do not insert if pt is sx
if asx, can test for STD and insert IUD- if tests return + treat appropriately
conventional pap - ANSWER wooden spatula is used to scrape cells and
examine for abnormalities
does not test for HPV
liquid prep - ANSWER endocervical brush is used to collect sample, can be
used for co-testing and can identify high risk HPV
cervical polyps - ANSWER large, friable (bleed easily)
caused by cervical hyperplasia
rarely dev into malignancy
cervical papillomas - ANSWER solid, benign
usually asx
true: unknown cause
condyloma: HPV- bx these
, combo oral contraceptives - ANSWER estrogen and progesterone
pills
nuvaring: left in place x 3 weeks, remove for one; can be left out for 3 hrs
without losing efficacy
patch: applied weekly, less effective in obese
extended use pills: delay/eliminate menstruation to decrease anemia,
dysmenorrhea, premenstrual depression; menstruation is not required bc
endometrial lining does not build up
+: increase BMD; decrease menorrhea, acne, PCOS, ovarian cysts, PID, ovarian
and endometrial CA, benign breast dx, and ectopic pregnancy
contraindications: smoker >35 yrs, hx of thromboembolytic event, hx/current
breast CA, uncontrolled HTN/DM, prolonged immobilization, triglycerides
>250, active liver dx, lupus, increased risk for CAD, undiagnosed vaginal
bleeding
progestin only contraceptives - ANSWER progestin only pills
depo-shot: IM q 3 months; best for sickle cell patients, can be used
immediately post-partum, may decrease BMD (take calcium supplements),
weight gain and mood changes
levonorgestrel IUD: effective x 3-5 yrs; may tx excessive bleeding, can be
used with breastfeeding; expulsion common during first few cycles and <6
wks post partum
implant: nexplanon; contraindicated with known/suspected pregnancy,
thrombolytic dx, liver dx, breast CA; remove if jaundice occurs, suspect
ectopic pregnancy if she becomes pregnant or has lower abdominal pain;
Correct Answers
chlamydia - ANSWER gold standard of testing is CX
NAAT can be used to also test for gonorrhea
treatment: azithromycin 1 g PO once (doxy if PCN allergy); azithromycin is
OK with pregnancy
gonorrhea - ANSWER NAAT, cx, or gram stain for testing
treatment: 250 mg ceftriaxone IM once PLUS azithromycin 1 g PO once
gonorrhea and chlamydia often occur together
gonorrhea is resistant to fluoroquinolones- treat with cephalosporins ONLY
syphilis - ANSWER requires 2 test for diagnosis
nontreponemal test: not specific for t.pallidum, seropositive (rx for life);
VDRL, RPR
treponemal: specific for t. pallidum antibodies; usually reactive for life
treatment: PCN G
primary: painless ulcer/chancre; perform nontreponemal test and treat with
PCN G 2.4 million units while awaiting results; if + confirm with treponemal
secondary: rash to palms/soles; all tests + and titers are highest
latent: asx with + tests
,HPV - ANSWER cytology is used to detect cervical dysplasia and provide
indirect evidence to HPV
cotest with Pap and HPV if >30 yrs or >25 yrs with ASC-US
can dx if genital warts obvious
patient applied tx: podofilox, imiquimod, sinecathechins; do NOT use with
pregnancy
provider administered tx: cryotherapy, trichloracetic acid, bichloracetic acid,
surgical excision
warts are more friable and proliferative during pregnancy
presence of warts is NOT an indication for c section
herpes - ANSWER culture is gold standard for testing
polymerase chain reaction is used to test spinal fluid
antiviral medications are used to control sx- will not eradicate virus, and does
not effect risk/freq/severity of outbreaks when DC'd
acyclovir 400 mg TID or 200 mg 5x/day
1st episode: 7-10 days of treatment
recurrent episode: 2-5 days of treatment
suppression therapy: daily
treatment may be extended if healing is not complete
bacterial vaginosis - ANSWER overgrowth of bacteria due to changes in
normal vaginal bacterial flora
always treat pregnant women with BV, it can cause pre-term labor
,metronidazole or clindamycin
goal is to re-establish normal vaginal pH or lactobacillis
PID - ANSWER usually caused by STD (gonorrhea or chlamydia)
treatment MUST cover gonorrhea, chlamydia, anaerobes, gram - bacteria,
and strep
ROCEPHIN, AZITHROMYCIN, METRONIDAZOLE
treat partners within 60 days of sx onset
IUD insertion and STDs - ANSWER do not insert if pt is sx
if asx, can test for STD and insert IUD- if tests return + treat appropriately
conventional pap - ANSWER wooden spatula is used to scrape cells and
examine for abnormalities
does not test for HPV
liquid prep - ANSWER endocervical brush is used to collect sample, can be
used for co-testing and can identify high risk HPV
cervical polyps - ANSWER large, friable (bleed easily)
caused by cervical hyperplasia
rarely dev into malignancy
cervical papillomas - ANSWER solid, benign
usually asx
true: unknown cause
condyloma: HPV- bx these
, combo oral contraceptives - ANSWER estrogen and progesterone
pills
nuvaring: left in place x 3 weeks, remove for one; can be left out for 3 hrs
without losing efficacy
patch: applied weekly, less effective in obese
extended use pills: delay/eliminate menstruation to decrease anemia,
dysmenorrhea, premenstrual depression; menstruation is not required bc
endometrial lining does not build up
+: increase BMD; decrease menorrhea, acne, PCOS, ovarian cysts, PID, ovarian
and endometrial CA, benign breast dx, and ectopic pregnancy
contraindications: smoker >35 yrs, hx of thromboembolytic event, hx/current
breast CA, uncontrolled HTN/DM, prolonged immobilization, triglycerides
>250, active liver dx, lupus, increased risk for CAD, undiagnosed vaginal
bleeding
progestin only contraceptives - ANSWER progestin only pills
depo-shot: IM q 3 months; best for sickle cell patients, can be used
immediately post-partum, may decrease BMD (take calcium supplements),
weight gain and mood changes
levonorgestrel IUD: effective x 3-5 yrs; may tx excessive bleeding, can be
used with breastfeeding; expulsion common during first few cycles and <6
wks post partum
implant: nexplanon; contraindicated with known/suspected pregnancy,
thrombolytic dx, liver dx, breast CA; remove if jaundice occurs, suspect
ectopic pregnancy if she becomes pregnant or has lower abdominal pain;
