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EPISODIC SOAP NOTE COMPREHENSIVE
SCRIPT 2026 SOLUTIONS VERIFIED A+
◉ chancroid vs chancre. Answer: - chancroid: bacterial disease w/ painful/irregular shape sores, localized infection
- chancres: results from syphilis stage 1, hard/raised edged sores that are non-tender ◉ chancroid. Answer: - bacterial disease w/ painful and irregular shaped sores; localized infection
- "kissing ulcers" can spread on yourself ◉ chancroid treatment. Answer: Azithromycin 1g single dose ceftriaxone IM ◉ HPV. Answer: - most common VIRAL STD
- usually painless, causes lesions but if all internal appears to be asymptomatic
- can cause cervical cancer
- can lay dormant for years
◉ high risk vs low risk HPV. Answer: - high risk: 16 and 18 (lead to cervical cancer)
- low risk: 6 and 11, 90% of infections ◉ HPV treatment. Answer: - no cure, but most females will clear on their own within 2 years
- imiquimode (aldara)
- topical agents can be used on ulcers ◉ mandated reportable STIs. Answer: gonorrhea, chlamydia, syphillis, canchroid, HIV/AIDs ◉ herpes type 1. Answer: - viral infection that mainly affects the mouth/facial region but CAN affect genital region ◉ herpes type 2. Answer: - more serious than type 1, affects genital region but CAN affect facial region; painful ulcers ◉ prodromal symptoms. Answer: - tingling felt prior to vesicle formation in herpes ◉ is herpes more common in males or females?. Answer: females, so male-female transmission is more common than female-male
◉ molluscum. Answer: - bumps along skin w/ hollow umbilicated lesions, common in kids but very contagious
- not sexually transmitted, but will be transmitted during sex d/t contagious nature
- skin to skin contact ◉ molluscum treatment. Answer: - will disappear on own eventually
- TCA, liquid nitrogen, retin A, decore lesions do NOT squeeze lesions ◉ when to test for HIV. Answer: when positive for any STD ◉ transmission of HIV. Answer: - sexual contact
- sharing needles
- blood transfusions (less common now)
- babies born to HIV+ females (via birth or breastfeeding) ◉ PEP vs PrEP. Answer: - PEP: post-exposure prophylaxis; take within 72hrs of exposire
- PrEP: pre-exposure prophylaxis; take daily if engaging w/ HIV+ person ◉ trichomonas presentation. Answer: - STD caused from parasite
- on exam, will see petechiae on cervix and frothy bubbles (trichomonas swimming) ◉ trichomonas s/s, diagnosis. Answer: - s/s: yellow/gray frothy vaginal discharge, frothy cervix on exam
- diagnosis: vaginal culture to see trich swimming, vaginal wet prep (potassium hydroxide) for whiff test (stench), NAAT test ◉ trichomonas treatment and prevention. Answer: - treatment: metronidazole 500mg for females x 7 days, 2g for males x1 dose (no alcohol!)
- prevention: condoms, abstinence both partners treated even if male asymptomatic ◉ bacterial vaginosis causes, s/s. Answer: - occurs when bacteria in vagina outnumber lactobacillus (normal/good vaginal bacteria)
- s/s: thin grey/white vaginal discharge, fishy odor, vaginal itching ◉ what type of vaginal pH will lead to increased bacterial growth. Answer: - pH more basic; >4. presence of semen will increase vaginal pH! presence of blood (ie spotting) will increase vaginal pH
◉ vulvovaginal candidiasis s/s. Answer: - females: itching/burning d/t fissures in labia, cottage cheese like thick white discharge
- males: balinitis (rash on foreskin), pain during intercourse won't be spread sexually, just uncomfortable ◉ diagnosis of candidiasis. Answer: - vaginal culture or vaginal wet prep (w/ KOH)
- vaginal pH most likely low (more acidic)- not fighting yeast off
- wet prep- budding hyphae ◉ treatment of candidiasis. Answer: - only treat if symptomatic!! even if you see yeast
- antifungal creams, suppositories, boric acid suppositories, yogurt w/ live cultures ◉ pelvic inflammatory disease causes. Answer: - mostly gonorrhea or chlamydia
- BV
- childbirth, d&c, IUD insertion
- infection from elsewhere (appendix, bloodstream, etc)
◉ PID pathophysiology. Answer: - pathogen infects cervix (which usually protects), travels upwards and invades cells of other organs, leads to inflammation and scarring ◉ PID s/s. Answer: - referred pain, rebound tenderness, cervical motion tenderness, swelling, abnormal discharge, fever, WBC TNTC (too numerous to count on wet prep) ◉ PID diagnosis. Answer: - gonorrhea and chlamydia culture!!
- pelvic and abdominal exam (tender)
- ultrasound ◉ PID treatment. Answer: - three abx used to kill any bacteria present (cef, doxy, metronidazole)
- pelvic rest, bedrest ◉ most dangerous group for PID. Answer: adolescents; hospitalize if < ◉ pubic lice. Answer: - infectious via contact
- use OTC shampoo
- wash all sheets and towels
◉ squamous epithelium vs. columnar epithelium. Answer: - squamous: covers vagina and outside of cervix, light pink
- columnar: immature cells inside inner cervix, dark red in color ◉ aging related to physiology of cervix. Answer: - in young females, more columnar cells are visible outside cervix (these are immature) which increases risk of acquiring HPV
- in older adults, squamous cells replace columnar cells in inner cervix, SCJ migrates in SCJ moves over time!! ◉ transformation zone. Answer: - Squamocolumnar junction (most common area for cervical cancer)
- zone between squamous and columnar cells, take pap sample here ◉ metaplasia. Answer: transformation of columnar cells into squamous cells ◉ USPSTF cervical cancer screening recs. Answer: - 21 - 29: Pap every 3 years
- 30 - 65: Pap and HPV every 5 years OR pap alone every 3 or HPV every 5 (add in HPV if pap irregular)
- stop at 65 if normal paps for 10 years, most recent within 5
◉ should you do a pap if pt had a hysterectomy?. Answer: - no more screening IF total hysterectomy was done for BENIGN reason
- if taken d/t cancer, screen for 20 years after surgery ◉ HPV testing. Answer: - reflex HPV: added on to irregular pap for ages 21- 29
- co-test: done w/ pap automatically ages 30- 65
- primary HPV test: tests specifically for HPV, guides treatment for irregular pap ◉ pap vs HPV tests. Answer: - pap: detects abnormal cells
- HPV: detects HPV specifically
- co-test: pap plus HPV (every 5yrs after 30)
- reflex HPV: add on to abnormal pap ◉ atypical squamous cells of undetermined significance (ASC-US). Answer: - changes in cervical cells d/t unknown cause, do more testing re-test in a year w/ HPV ◉ low-grade squamous intraepithelial lesion (LSIL). Answer: - CIN subtype which usually regresses, but can persist or progress to the other type; standard care is careful observation
◉ how to manage ASCUS result. Answer: - under 25: cp-test in one year
- over 25: test HPV
- ASCUS w/ - HPV: re-test in a year
- ASCUS w/ +HPV: colposcopy if over 25, follow up in a year if under ◉ genital warts patho, s/s. Answer: - HPV strains 6 and 11
- painless bumps w/ itching ◉ genital warts differential diagnoses. Answer: - molluscum
- condyloma lata (secondary syphilis)
- carcinoma ◉ genital wart treatment. Answer: - will relieve s/s but does not kill the virus
- patient applied solutions/gels (podofilox 0.5%, imiquimod 5%, veregen ointment)
- provider administered treatment (TCA, cryotherapy, surgical removal) ◉ genital wart (HPV) transmission. Answer: - can appear months after transmission
- use condoms but might not protect
- avoid sex until warts all gone ◉ general HPV vaccine schedule. Answer: - should get prior to sexual activity (as early as 9y/o), but better to get than not to get
- get routinely through age 26 common side effect: syncope ◉ HPV vaccine schedule +/-14 years. Answer: - age 14 and under: two doses 6mo apart
- age 15 and up: three doses over 6 mo (0, 2, and 6 months) ◉ LGBTQUIA+ disparities 65+. Answer: - disability
- depression
- tobacco use
- alcohol use
- poverty
- family estrangement
- isolation ◉ LGBTQUIA+ disparities in youth. Answer: - substance use
- tobacco use
- multiple sex partners
◉ F/TDF (Truvada) vs F/TAF (Descovy). Answer: - Descovy (F/TAF) not approved for vaginal sex ◉ what to look at before prescribing PrEP. Answer: - MUST have negative HIV test
- no s/s HIV
- normal renal and liver function ◉ PrEP follow up. Answer: - HIV tests Q3 mo
- STD screenings Q3-6 mo
- kidney function Q6mo
- pregnancy screening Q3 mo
- monitor for Hep B (risk if you withdraw PrEP abruptly) ◉ PEP instructions. Answer: - take within 72 hrs of exposure
- 3 meds x 28 days ◉ if unsure of HIV status, which med to start?. Answer: - PEP, never start PrEP until you know HIV test results
- can always switch from PEP to PrEP after 28 day course is complete
- examples: exposed to HIV during sex or w/ shared needles OR healthcare exposure
◉ when to stop pap smears and mammograms for transgender males. Answer: - stop pap only if total hysterectomy for non- cancerous reason
- stop mammo only if mastectomy has occurred ◉ things to consider for pap smear in transgender males. Answer: - inflammation/atrophy might be present
- vaginal estrogen for 1-2 weeks prior to exam
- record any testosterone on requisition
- offer self swab option (if only STI testing, no speculum exam necessary) ◉ things to consider for prostate exam in transgender females. Answer: - estrogen use can shrink prostate
- decision should be made based on guidelines for non-transgender male ◉ what to screen for w/ vaginoplasty. Answer: - Pap (STD testing)
- HPV ◉ masculinization meds (FTM) labs to monitor. Answer: - lipids (hypercholesterolemia)
- CBC (polycythemia)
- CMP (lytes)
- reconciliation: repent, apologize
- calm or loving: promise it will never happen again ◉ how to diagnose menopause, unnatural causes of menopause. Answer: - diagnosis can be made after 12 mo of amenorrhea with no other identifiable cause
- unnatural causes: total hysterectomy with BSO (ovaries removed), chemo, radiation ◉ what hormone is directly related to menopause? Normal range before and after menopause?. Answer: - estrogen
- before menopause: 100- 800
- after menopause: lower than 37 ◉ menopause in relation to the HPO axis. Answer: - ovarian follicle production stops
- FSH/LH remain high
- estrogen and progesterone levels low ◉ factors contributing to early menopause. Answer: - smoking
- low socioeconomic status
- low body weight (BMI < 19)
- nulliparity (has never given birth)
- genetic- mother w/ early menopause (highest contributing factor) ◉ differential diagnoses to menopause (MUST rule out). Answer: - pregnancy
- diabetes (hot flashes)
- hypertension (headaches)
- arrhythmias (fatigue)
- thyroid disease (hot flashes)
- anemia (fatigue)
- depression (mood swings) ◉ first line pharm treatment for menopause vasomotor symptoms. Answer: - SSRIs (paroxetine, venlafaxin, fluoxetine) ◉ Menopause hormone therapy (MHT): what to consider. Answer: - lowest dose for shortest amount of time
- pref transdermal over oral (lower dose d/t no first-pass) ◉ hormone therapy in women w/ uterus vs. w/o. Answer: - with uterus: estrogen and progesterone
- without uterus: estrogen alone
