Genital chancre begins as a papule, ulcerates to form a single, painless, clean-based ulcer. TOW?
Cause of genital chancre, begining as a papule, ulcerating to form a single, painless, clean-based ulcer.
A pen-allergy, non-pregnant, female pt w/ fever, "copper penny" macular lesions on the palms or soles; RPR(+) should be treated with
Management choice of tabes dorsalis (10-20yrs), iritis, uveitis, or Argyll-Robertson pupils of pen-allergy in a pregnant woman w/ pen allergy; RPR(+) is
Hx of painful clustered vesicles with an erythematous base; urinary retention in a promiscuous woman. TOW?
HSV-2 >> 1
Giemsa stain of fluid from a herpetic lesion should reveal
Multinucleated giant cells
Patient with genital herpes does not respond to acyclovir because pt is infected with
thymidine kinase deficient HSV
A pregnant woman with 1o symptomatic HSV-2 infection is at risk of her baby developing
neonatal (congenital) herpes
Cause of painful genital ulcers; purulent, grey base; painful inguinal adenitis, in a man with multiple sexual partners is
Fastidious organism in the infiltrate of the penile ulcer, co- localized with neutrophils and fibrin, in a pt w/ chancroid is
All sex partners of pt with chancroid, regardless of symptoms, should be examined and treated with
Azythromycin > ceftriaxone
Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman
Chlamydia trachomatis D-K
Dx of mucopurulent urethral discharge, dysuria, penile pruritis is based on
NAAT of urethral specimen or urine (+)
DOC of most frequent cause of nongonococcal urethritis
Azythromycin > doxycycline
Cause of rare genital ulcers, inguinal lymphadenopathy [cytology(-) for multi-nucleated giant cells; RPR (-)] in men is
Chlamydia trachomatis L1-L3
Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?
Cause of mucopurulent urethritis, dysuria, penile pruritis [Smear (+):Gram-negative diplococci co-populated w/ PMNs] is
Deficiency in serum factors in a female pt w/ frequent gonorrhea and DGIs is
Immune evasion of Neisseria gonorrhoeae in frequent mucosal infection is due to
Antigenic variation of pili.
Auxotrophic strains of N. gonorrhoeae with serum (complements) resistance are likely to cause
Septic arthritis (aka: DGI)
Most frequent complication of gonococcal (GC) infection in men
Cause of "bull headed clap", urethral stricture, prostatitis is
Urethritis is treated with ceftriaxone + azythromycin because
Concurrent GC + Chlamydia
An older woman with PID and tubo-ovarian abscess receives ceftriaxone, azythromycin, and metronidazole because
Polymicrobic (endogenous) infection
Cause of anogenital warts w/ histology (+): koilocytes is
HPV 6 and 11
Cause of atypical squamous cells of undetermined significance (ASCUS) on pap smear w/ no clinical signs of infection is
HPV 16 and 18
Cause of koilocytotic cells and possible progression to squamous cell carcinoma
HPV 16 and 18
Next step to identify viral cause of ASCUS on pap smear w/ and further management in a woman of age > 29 years is
Colposcopy > HPV DNA in bpsy
Wet prep of vaginal discharge from a pt w/ vaginal pruritis; ectocervical erythema ("strawberry cervix") should reveal
motile tissue flagellate
Gram stain of vaginal discharge w/ fishy odor from a pt w/ vaginal pruritis but no erythema and normal cervix should reveal
SECs stippled with Gram- variable organisms.
Pathology of bacterial vagisnosis is overgrowth (in vagina) of anaerobic Mobiluncus species and
DOC of bacterial vaginosis is
Wet prep of curdy discharge (no odor), adhering to vaginal walls, from a pregnant woman w/ recent UTI, who now has severe vaginal pruritis; vulvovaginal area - erythematous should reveal
budding yeasts with pseudohyphae
Normal commensal of skin, GI & GU tracts; endogenous overgrowth of budding yeast, capable of >10 diseases. TOW?
Mechanism of action of a po DOC of vulvovaginal candidiasis is
blocks C14α-lanosterol demethylase
Hx of flu-like illness, lymphadenopathy, maculopapular rash in a bisexual man. Lab: lymphopenia and transaminase elevations; monospot/all serology (-). TOW?
Acute retroviral syndrome
Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is
Hx of mononucleosis-like illness and lymphadenopathy in a man who has sex man. Serology (-). What is HIV viral load?
Host-cell receptor for HIV-1 infection
Homozygous for deletions in what gene renders resistance to infection and some protection against progression.
Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are
A man, who practices "sex with another man", has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?
What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?
Virus continues to replicate low level.
A man who practices "sex with another man", is now HIV-1 serology (+) and has dual symptomatic infections/cancer (any two from below). Expected CD4+ count is
i. Candidiasis, esophageal, bronchi, trachea, or lungs
ii. Cervical cancer, invasive
iii. Coccidioidomycosis, extrapulmonary
iv. Cryptococcosis, extrapulmonary
v. Cryptosporidiosis, chronic intestinal
vi. Cytomegalovirus retinitis (with vision loss)
vii. Encephalopathy, HIV-related
viii. Herpes simplex - Chronic ulcers
ix. Histoplasmosis, disseminated or extrapulmonary
x. Isosporiasis, chronic intestinal (duration >1 mo)
xi. Kaposi sarcoma
xii. Lymphoma, Burkitt
xiii. Lymphoma, primary, of the brain
xiv. Mycobacterium avium complex or Mycobacterium kansasii infection, extrapulmonary
xv. Mycobacterium tuberculosis infection, any site (pulmonary or extrapulmonary)
xvi. Pneumocystis pneumonia
xvii. Progressive multifocal leukoencephalopathy
xviii. Wasting syndrome due to HIV infection
CD4+ < 200/μL
A man with HIV infection has chronic diarrhea, oral thrush + toxoplasma encephalitis. Most likely CD4+ count is
< 50 cells/μL.
Most common cause of HIV- associated peripheral skin or mucosal ulcers
HSV-1 (>> Histo > CMV > VZV > Syphilis)
Most common cause of HIV- associated nodules (neoplasia)?
HHV-8 (aka KSHV)
Hx of fatigue, nausea, abdominal pain, diarrhea, fever, chills, night sweats, dry persistent cough w/ SOB and weight loss in a man with AIDS. Lab: PPD (-); blood culture (+) for AFB. TOW?
Mycobacterium avium- intracellulare (MAI) complex (aka: MAC)
Common cause of retinitis, viral pneumonitis or esophagitis in AIDS
Cases of CMV disease occur with immunosuppression level
cytopathology of CMV infected tissue is characterized by large cells with
nuclear (Cowdry owl's eye) and cytoplasmic inclusions
Hx of progressive CNS dz in a pt w/ AIDS: hemiparesis, visual, ataxia, aphasia, cranial nerves, sensory. Head MRI: ring- enhancing lesions. Toxo antibody (-). TOW?
Definitive indication for initial HAART is CD4+ count?
Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL
< 50 copies RNA/mL.
Initial regimen of anti-retroviral therapy is
Emtricitabine + Tenofovir + Efavirenz
Abacavir, emtricitabine, lamivudine, zidovudine, tenofovir belong to what class of antiretrovirals?
Efavirenz, nevirapine belong to what class of antiretrovirals?
Atazanavir, Lopinavir, Saquinavir belong to what class of antiretrovirals?
This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.
This drug inhibits integrase, responsible for insertion of HIV proviral DNA into the host genome.
A man has AIDS and CD4 <200cells/μL or thrush. Antibacterial prophylaxis needed besides HAART is
TMP-SMX (for PCP)
A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is
TMP-SMX (for Toxoplasma encephalitis)
A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is
INH + pyridoxine
A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is
azithromycin (for MAC)
Hx of fever, a pustule at a cat scratch site, adenopathy, hepatosplenomegaly in a pt w/ AIDS. Warthin-Starry stain tissue (+). TOW (clue: bacillary angiomatosis)?
Leading causes of congenital infections are
ToRCH3eS-List To = Toxoplasma gondii R = Rubella C = CMV H = HSV-2 H = HIV H = HBV S = Syphilis List = Listeria monocytogenes
Cause of severe CNS sequelae, chorioretinitis, systemic disease in a neonate (mom at pregnancy had mono-like illness after eating undercooked beef or pork or exposure to oöcysts in cat feces) is
Drug for pregnant woman in first trimester to prevent transmission if mother seroconverts is
Hx of deafness, cataracts, heart defects, or microcephaly in a child (of a seronegative, caregiver mom, exposed to "Blueberry muffin baby" in 1st trimester). TOW?
congenital rubella syndrome (CRS)
Dx of CRS usually with positive anti-rubella antibody type?
Microcephaly, seizures, sensorineural hearing loss, feeding difficulties, petechial rash, hepatosplenomegaly, or jaundice in a neonate. PCR of any body fluid should yield
After primary infection, CMV, characterized as enveloped dsDNA betaherpesvirus; establishes
Hepatosplenomegaly, neurologic abnormalities, frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received
Cause of vesicular skin lesions + conjunctivitis in a child (asymptomatic at birth)
Hx of cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, and saber shins. Hutchinson teeth, + CN VIII deafness in a neonate (mom is a prostitute). TOW?
Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?