Term
| What percent of HSV 1 is above the waist? |
|
Definition
|
|
Term
| What percent of type 2 herpes is below the waist? |
|
Definition
|
|
Term
| What is the classical symptoms progression of genital herpes? |
|
Definition
| presthesias followed by painful grouped vesicles and vesiculopustules on an erythematous base that evolve to erosions and crusts |
|
|
Term
| Where else below the waist besides the perineal area is genital herpes likely to present? |
|
Definition
| on the buttocks or sacral area |
|
|
Term
| What kind of lesions can you perform the Tzanck prep on? |
|
Definition
| acute vesicular lesions of genital herpes |
|
|
Term
| What are you looking for on Tzanck prep? |
|
Definition
| epidermal giant cells (can be caused by herpes or VZV) |
|
|
Term
| What is the sensitivity of the Tzanck prep? |
|
Definition
|
|
Term
| When is it appropriate to biopsy for genital herpes lesions? |
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Definition
|
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Term
| T/F Biopsy is more sensitive and specific for genital herpes than the Tzanck prep. |
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Definition
| false; they have about the same sensitivity and specificity |
|
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Term
| What kinds of tests can you perform on acute or crusted/eroded genital herpes lesions? |
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Definition
| direct flourescent antibody test or viral culture |
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Term
| What are the advantages to doing the direct flourescent antibody test? |
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Definition
| quick, better sensitivity, gives virus type |
|
|
Term
| How long does it take to do a viral culture? |
|
Definition
|
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Term
| What are the pros to using viral culture to diagnose genital herpes? |
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Definition
| very sensitive and gives viral type |
|
|
Term
| Which is better to treat genital herpes, systemic or topical therapy? |
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Definition
|
|
Term
| How do you treat genital herpes? |
|
Definition
| acyclovir 5x a day or valacyclovir/famciclovir less often |
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Term
| Where in the cell does molluscum contagiosum replicate? |
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Definition
|
|
Term
| What type of virus is molluscum contagiosum? |
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Definition
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Term
| How do you diagnose molluscum contagiosum? |
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Definition
| clinical appearance and biopsy |
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|
Term
| How long does molluscum last? |
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Definition
| individual lesions last 2-4 months; duration of infection is about 2 years |
|
|
Term
| How do you treat molluscum contagiosum? |
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Definition
| let them resolve spontaneously, curettage, cyrotherapy, salicylic acid, retin-A, imiquimod |
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Term
| Genital warts that have reached a very large size are termed ________. |
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Definition
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|
Term
| What variants of normal can look like penile warts? |
|
Definition
| pearly penile papules or sebaceous glands |
|
|
Term
| How do you diagnose genital warts? |
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Definition
| clinical appearance is sufficient, biopsy can confirm |
|
|
Term
| How are genital warts managed? |
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Definition
| cyrotherapy, topical podophyllin or imiquimod; possibly surgical resection |
|
|
Term
| What should you rule out after successfully treating a patients genital warts? |
|
Definition
| cervical disease and/or anal squamous cell carcinoma |
|
|
Term
| How long does it take for scabies eggs to form adult mites? |
|
Definition
|
|
Term
| How long after the initial infestation of scabies does it take for symptoms to begin? |
|
Definition
|
|
Term
| How is scabies transmitted? |
|
Definition
| close personal contact, often sexual |
|
|
Term
| How does scabies affect the skin? |
|
Definition
| female mite burrows through the stratum corneum and lays eggs |
|
|
Term
| What is the classic presentation of scabies? |
|
Definition
| severe pruritis, worse at night; symmetrical burrows and papulovesicles; predilection for fingerwebs, wrists, axillae, genitalia, breasts |
|
|
Term
| How do you make the diagnosis of scabies? |
|
Definition
| skin scraping of a burrow with mineral oil prep; look for the mite, fecal pellets (scybala), and eggs, or biopsy |
|
|
Term
| What are the fecal pellets of scabies mites called? |
|
Definition
|
|
Term
|
Definition
| permethrin cream, lindane lotion, crotamiton cream; Ivermectin orally for severe disease |
|
|
Term
| It is important to tell people with scabies to... |
|
Definition
| treat partners/household members and wash all clothes and bed linen, and the pruritis will persist for weeks after mites are killed |
|
|
Term
| What is the medical term for lice? |
|
Definition
|
|
Term
| What are the different types of pediculosis? |
|
Definition
head lice= pediculus humanus, var. capitis
body lice= pediculus humanus, var. corporis
pubic lice= phthirius pubis |
|
|
Term
| How are pubic lice spread? |
|
Definition
| usually sexually transmitted but can also be spread by clothing |
|
|
Term
| What is the classic presentation of pediculosis? |
|
Definition
| moderate intensity pruritus; small red papules or small blue-gray macules (maculae cerulae) |
|
|
Term
| Where else on the body are pubic lice often found? |
|
Definition
|
|
Term
| How do you diagnose pediculosis pubis? |
|
Definition
| search with hand lens for nits and lice |
|
|
Term
| How do you manage pediculosis pubis? |
|
Definition
| permethrin cream, lindane lotion, malathion |
|
|
Term
| Describe the appearance of Neisseria gonorrhea. |
|
Definition
| gram-negative intracellular diplococci |
|
|
Term
| What are the symptoms of anal-rectal infection with neisseria gonorrhea? |
|
Definition
| asymptomatic or with rectal bleeding, discharge, and tenesmus |
|
|
Term
| What patient populations are susceptible to hematogenous dissemination of gonorrhea? |
|
Definition
| women > men; particularly pregnant women |
|
|
Term
| What are the symptoms of hematogenously disseminated gonorrhea? |
|
Definition
| acrally-distributed hemorrhagic papulopustules with arthritis |
|
|
Term
| How is gonorrhea diagnosed? |
|
Definition
gram stain= gram-negative intracellular diplococci
culture |
|
|
Term
| What kind of media is needed for gonorrhea diagnosis? |
|
Definition
|
|
Term
| How do you treat gonorrhea? |
|
Definition
| single dose regimens of 3rd generation cephalosporin or flouroquinolone for uncomplicated disease; additionally should treat for chlamydia with azithromycin or doxycycline |
|
|
Term
| What bug causes chancroid? |
|
Definition
|
|
Term
| What is the appearance of haemophilus ducreyi? |
|
Definition
| gram-negative pleomorphic rod |
|
|
Term
| What is the classic presentation of chancroid? |
|
Definition
| painful, soft, ragged ulcer with a dirty yellow membrane and "kissing" ulcers in apposition to initial ulcer; tender suppurative inguinal adenopathy |
|
|
Term
| How is chancroid diagnosed? |
|
Definition
| gram stain, culture, or biopsy |
|
|
Term
| What is the gold standard for diagnosis of chancroid? |
|
Definition
|
|
Term
| What is looked for on gram stain of chancroid? |
|
Definition
|
|
Term
| What is the sensitivity of gram stain for chancroid diagnosis? |
|
Definition
|
|
Term
| How do you treat chancroid? |
|
Definition
| single dose of azithromycin or ceftriaxone |
|
|
Term
| What organism causes lymphogranuloma venereum? |
|
Definition
|
|
Term
| What is the classic presentation of lymphogranuloma venereum? |
|
Definition
| an evanescent painless 2-3 mm vesicle or erosion; 2 weeks later painful enlargment of regional lymph nodes (buboes) along Poupart's ligament which forms a "groove sign" |
|
|
Term
| T/F "Groove sign" is a physical exam finding specific for lymphogranuloma venereum. |
|
Definition
|
|
Term
| What happens if lymphogranuloma remains untreated? |
|
Definition
| nodes become matted and suppurative and form sinus tracts; lymphatic blockage leads to elephantiasis of the genitals (esthiomene) and significant tissue destruction and deformity |
|
|
Term
| How is lymphogranuloma venereum diagnosed? |
|
Definition
| complement fixation serologic tests; detects antibodies, titer of 1:80 or more is significant |
|
|
Term
| How is lymphogranuloma venerum treated? |
|
Definition
| doxycycine; aspiration of buboes to drain purulent material and prevent rupture |
|
|
Term
| What is another name for granuloma inguinale? |
|
Definition
|
|
Term
| What is the name of the organism that causes granuloma inguinale? |
|
Definition
| calymmatobacterium granulomatis |
|
|
Term
| Describe the appearance of calymmatobacterium granulomatis. |
|
Definition
|
|
Term
| What is teh classic presentation of granuloma inguinale? |
|
Definition
| flat-topped papule or nodule evolves into a painful ulcer with hypertrophic, vegetative, "beefy-red" granulation tissue that bleeds easily |
|
|
Term
| What happens if granuloma inguinale is left untreated? |
|
Definition
| leads to significant tissue destruction and deformity and predilection for SCC |
|
|
Term
| How do you diagnose granuloma inguinale? |
|
Definition
| clinical appearance, tissue smear, biopsy with Giemsa or silver stain |
|
|
Term
| Granuloma inguinale can be confused with what other disease? |
|
Definition
| squamous cell carcinoma (granuloma inguinale can actually contribute to the development of SCC of the penis and anal region) |
|
|
Term
| How is granuloma inguinale treated? |
|
Definition
| bactrim, tetracycline, or doxycycline; surgery to correct disfigurement |
|
|
Term
| Syphilis is caused by which organism? |
|
Definition
|
|
Term
| What is primary syphilis? |
|
Definition
| localized disease of genitalia at initial site of infection |
|
|
Term
| What is secondary syphilis? |
|
Definition
| generalized manifestations due to spirochetemia with numerous clinical patterns |
|
|
Term
| What is tertiary syphilis? |
|
Definition
| late manifestations resulting from longstanding chronic infection of various organ systems including CNS and cardiovascular system |
|
|
Term
| How long does it take for spirochetes of syphilis to hematogenously disseminate? |
|
Definition
| 3-8 weeks after appearance of chancre |
|
|
Term
| What is the incubation period from innoculation with syphilis to primary syphilis? |
|
Definition
|
|
Term
| How long does it take for the cutaneous lesions of secondary syphilis to disapear spontaneously? |
|
Definition
|
|
Term
| What percent of patients with latent syphilis relapse into secondary syphilis within the first 1-2 years? |
|
Definition
|
|
Term
| How long does it take for latent syphilis to become tertiary syphilis? |
|
Definition
|
|
Term
| Describe the classic presentation of primary syphilis. |
|
Definition
| single, painless ulcer (chancre) with clean smooth base and raised indurated borders with minimal surrounding inflammation. Rubbery to firm consistency when palpated; painless regional adenopathy |
|
|
Term
| Although the chancre of primary syphilis is most often found on genital skin, it can less comonly be found on the... |
|
Definition
| anus, lips, fingers, etc. |
|
|
Term
| List some of the manifestations of secondary syphilis. |
|
Definition
| papulosquamous eruption, condyloma lata, mucous pathches in oral cavity, moth-eaten alopecia, generalized lymphadenopathy |
|
|
Term
| Describe the papulosquamous eruption of secondary syphilis. |
|
Definition
| pityriasis rosea-like with prominent facial and palm and sole involvement ("copper pennies") |
|
|
Term
| What are the cutaneous presentations of tertiary syphilis? |
|
Definition
| nodular or plaque-like lesions, often annular, cutaneous extension from underlying bony gummatous lesion |
|
|
Term
| How do you diagnose syphilis? |
|
Definition
| clinical presentation, treponemal (FTA-ABS) and non-treponemal serologic tests (VDRL, RPR), biopsy |
|
|
Term
| How do you diagnose primary syphilis? |
|
Definition
| darkfield eamination (not widely available), VDRL may be negative, biopsy can suggest |
|
|
Term
| How do you diagnose secondary syphilis? |
|
Definition
| nontreponemal and treponemal tests usually positive |
|
|
Term
| How do you diagnose tertiary syphilis? |
|
Definition
| nontreponemal tests often positive and treponemal tests always positive |
|
|
Term
|
Definition
| penicillin (erythromycin for penicillin allergic) |
|
|
Term
| What are the cutaneous stigmata of congenital syphilis? |
|
Definition
| saddle nose deformity, frontal bossing, rhagades (perioral fissuring), saber shin, hutchinson's triad, higoumenaki's sign |
|
|
Term
| What is hutchinson's triad? |
|
Definition
| malformed (hutchinson's) teeth, corneal inflammation, and VIIIth nerve deafness |
|
|
Term
| What is Higoumenaki's sign? |
|
Definition
| unilateral thickening of clavicle |
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