final CMN 572 Questions and Answer
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
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
