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Be familiar with the interactive activities throughout course modules. You could
see variations of those same questions on your exams.
Week 1 Community Acquired Pneumonia (CAP) o Common pathogens S. pneumoniae, Mycoplasma spp., H. influenzae, and Staphylococcus aureus o First line treatment for previously healthy adults Streptococcus pneumoniae (pneumococcus) :Penicillin G, penicillin V, and amoxicillin in susceptible strains: Resistant strains: a cephalosporin, ampicillin Mycoplasma pneumoniae: Erythromycin, clarithromycin, azithromycin, and a tetracycline (causes discoloration in teeth in children) First line treatment is oral amoxicillin, doxycycline, or macrolides. What to give if first drug didn’t work
Streptococcus pneumoniae (pneumococcus): Erythromycin, azithromycin,
clarithromycin, levofloxacin, gemifloxacin, moxifloxacin, meropenem,
imipenem, ertapenem, trimethoprim/sulfamethoxazole, clindamycin, a
tetracycline, and vancomycin
Mycoplasma pneumoniae: A fluoroquinolone
If failed macrolide or doxycycline occurs, reasons are either medication
adherence issues or the presence of resistant organisms. The use of the
respiratory fluroquinolones is warranted.
o Treatment for M. Pneumoniae in pediatric patient (Specific/example antibiotic from drug class will be provided) o Atypical pneumonia is more commonly seen in children and young adults. Mycoplasma pneumoniae is the typical causative organism, followed by Chlamydia pneumoniae and Legionella pneumoniae. L. pneumoniae is more common in areas where moisture levels are high and carries a higher mortality risk (File, 2020). These patients are less likely to have a fever and usually present with complaints of fatigue accompanied by a cough that interferes with sleep. This form of atypical pneumonia is often thought to be a cold and managed symptomatically with over-the-counter medications unless medical care is sought. It is commonly referred to as 'walking pneumonia'. Treatment is similar to CAP. o If the patient took antibiotics in the last 3 months, the recommendation is to use medication from a different medication class. Doxycycline is an alternative to a macrolide. The preferred Beta-lactamase antimicrobial medications are high-dose (3 g daily) amoxicillin or high-
dose (4 g daily) amoxicillin-clavulanate (Augmentin®). Alternative Beta-lactamase is second-and third-generation cephalosporins such as cefuroxime (Ceftin®, Zinacef®), cefpodoxime (Vantin®), or ceftriaxone (Rocephin®) intramuscular o Treatment of CAP in pregnancy o Tetracycline cause fetal harm in animal studies, should be avoided in pregnancy. o If someone has been treated with an antibiotic in the previous 90 days of contracting CAP, a quinolone would be a prudent choice to prescribe. Floxacin Be familiar with drug examples within the antibiotic classes.
Beta-lactam:
Penicillins: Narrow Spectrum PCN (PCN sensitive): PCN G & PCN V (Streptococcus
Spp, Neisseria spp)
Narrow Spectrum PCN (PCN resistant): Nafcillin; Oxacillin; Dicloxacillin
(Staphylococcus aureus)
Broad Spectrum PCN: Ampicillin, Amoxicillin (H. influenza, E. Coli, Proteus
mirabilis, enterococci, and N. gonorrhoeae)
Extended- spectrum PCN: Piperacillin (Same as broad spectrum plus,
Pseudomonas aeruginosa, Enterobacter spp. Proteus, Bacteriodes fragilis
and many Klebsiella spp)
Cephalosporins: First generation (Cephalexin): (Narrow) Gram + Staphylococci or
streptococci
Second Generation (Cefoxitin): (More broad than 1st) Gram + & - H.
influenza, Klebsiella, pneumococci, and staphylococci
Third generation (Cefotaxime) (More than 1st^ and 2nd) Gram –
Pseudomonas aeruginosa, N. gonorrhoeae, and Klebsiella Serratia
Fourth generation (Cefepime) (Narrow) Gram – Pseudomonas
aeruginosa
Fifth generation (Ceftraroline): (Narrow) Gram + MRSA
Carbapenems: Beta-lactam ABT that have a broad antimicrobial spectra, although
none are active against MRSA. All are delivered parenteral, to
delay resistance these drugs should be reserved for pt who cannot
be treated with narrow-spectrum agents. Imipenem; Meropenem;
Ertapenem; Doripenems
Vancomycin (does not have a beta-lactam ring. It inhibits cell wall synthesis and thereby
promotes cell lysis and death. Active only against gram + bacteria.
Tetracyclines (bacteriostatic) Broad spectrum. 7 kinds. Tetracyclines (short acting),
demeclocycline (intermediate-acting), (the rest are long acting)
doxycycline, eravacycline, omadacycline, sarecycline, minocycline.
Macrolides (bacteriostatic) Broad spectrum. Called macrolides because they are big.
Erythromycin (oldest member), azithromycin, and clarithromycin.
Clindamycin (bacteriostatic) (not a Macrolide) Can promote severe C Diff. Active against
most anaerobic bacteria (+&-)
Aminoglycosides (Bactericidal) (narrow spectrum, primarily used against aerobic gram –
bacilli. Ex: Gentamicin, tobramycin, and amikacin.
Sulfonamides (usually bacteriostatic) (Sulfadiazine) and Trimethoprim: Combo =
Bactrim
o How to treat: Treatment of CDI consists of stopping one antibiotic and starting another. Start Vanco or Fidaxomicin
Recommended Treatments for Clostridiodies Difficile Infection
Clinical Definition Preferred Drug Therapy Alternative Drug Therapy
Initial episode: mild or moderate Vancomycin 125 mg PO qid or
fidaxomicin 200 mg PO bid for 10 days Metronidazole, 500 mg PO tid
daily for 10 days
Initial episode: fulminant Vancomycin 500 mg PO qid Vancomycin,
500 mg PR qid daily in patients with ileus
Initial episode: severe, complicated Leukocytosis with a WBC count of
15,000/μL or higher or SCr 1.5 times baseline or higher, either one, plus
hypotension/shock, ileus, and megacolon
Metronidazole 500 mg IV q 8 h plus vancomycin, 500 mg PO/NG qid for 10–
days
If complete ileus is present, consider adding vancomycin retention enema
First recurrence Vancomycin as a tapered and pulsed regimen or fidaxomicin
for 10 days Vancomycin standard dose for 10 days if metronidazole was
used in the first episode
Second recurrence
Vancomycin PO in a tapered regimen, for example:
125 mg qid for 10–14 days, then
125 mg bid for 7 days, then
125 mg qd for 7 days, then
125 mg q 2–3 d for 2–8 weeks
o Drug class known for ALL drugs in class to promote development of C. Diff. Antibiotics most likely to promote CDI are clindamycin, second- and third- generation cephalosporins, and fluoroquinolones. In fact, intensive use of fluoroquinolones such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) is considered responsible for the rapid spread of the NAP1/BI/027 strain. (Bacteriostatic inhibitors) One question from article in required reading list: o Ungureanu, G., Alexa, I.-D., & Ungureanu, M.-C. (2018). Unnecessary Medicine, an Issue with Major Ethical Implications. Internal Medicine / Medicina Interna, 15(5), 65–74. Penicillin o Cross-sensitivity reactions with which drug classes: pts allergic to one pnc should be considered allergic to all other pnc. In addition, few pt display cross sensitivity to cephalosporins o Prescribing in pregnant patients: Although there are no well-controlled studies in pregnant women, evidence we do have suggests there is no second or third trimester fetal risk. Cephalosporins o Patient education needed: contraindication for pt with hx of allergic rx to cephalosporins and severe rxn to PNC. Monitor for improvement. Monitor for any s/s of C-Diff occurrence, must report increase in stool.
o Prescribing in pregnant patients: All celphalosporins appear safe for use in pregnancy. Tetracyclines o Patient education needed: All tetracyclines can increase the sensitivity of the skin to ultraviolet light. The most common result is exaggerated sunburn. Advise patients to avoid prolonged exposure to sunlight, to wear protective clothing, and to apply a sunscreen to exposed skin. Admin med 1 hr before or 2 hr after any chelating agents (metal ions). Pts should report any s/s of c-diff and fungi growth. take all meds as prescribed to avoid superifections. o Prescribing in pregnant patients: Animal studies reveal that tetracyclines can cause fetal harm in pregnancy. Thus this class of drugs should be avoided in pregnant women. Macrolides o Patient education needed: Can cause QT prolongation and sudden cardiac death. Erythromycin is considered one of the safest antibiotics. Report any new GI disturbances. Aminoglycosides o Patient education needed: aminoglycosides can produce serious toxicity, especially to the inner ears and kidneys. Can accumulate in the inner ears and cause cellular injury impairing hearing and balance. Risk of ototoxicity related primarily to excessive trough levels, not excessive peak levels. Black box warning: Use of aminoglycosides is associated with irreversible ototoxicity. Neurotoxic symptoms may also include numbness, tingling, muscle twitching, and seizures. This risk increases in patients on high doses or with prolonged use and in patients with preexisting renal impairment. Sulfonamides o Patient education needed: Instruct patients to complete the prescribed course of treatment even though symptoms may abate before the full course is over. o • Patients taking oral sulfonamides should drink at least 8 to 10 glasses of water or other noncaffeinated fluids per day to decrease the risk for crystalluria. (Caffeine may be taken in addition to the other fluids.) o • To prevent photosensitivity reactions, advise patients to avoid prolonged exposure to sunlight, to wear protective clothing, and to apply sunscreen to exposed skin. Tanning beds are to be avoided. o • Patients should be instructed to observe for alterations that may indicate hypersensitivity (e.g., rash) and to report these promptly if they occur. o Prescribing in pregnant patients: sulfonamides should not be given to pregnant patients after 32 weeks of gestation or to those who are breastfeeding. Systemic sulfonamides may cause birth defects, especially if taken during the first semester. If taken near term, the infant may develop kernicterus. Gentamicin o Renal adjustments: gentamicin is toxic to the kidneys and inner ears. Caution must be exercised when gentamicin is combined with other nephrotoxic or ototoxic drugs. Accordingly, to avoid serious toxicity, we must reduce dosage size or increase the dosing interval in patients with kidney disease.
o Patient teaching: Advise pts of metallic taste, avoid ETOH d/t disulfiram like reaction. It is recommended that concurrent treatment of partner if partner if STI. Abacavir o Adverse effects: Lactic acidosis,a severe hepatomegaly with steatosis,a severe hypersensitivity reactions,a headache, nausea, vomiting, fatigue, malaise, sleep disorders Monitoring needs for long-term antifungal use: So baseline information was we'll need to know liver function. We want prompt recognition of liver injury with oral antifungal drugs. So we want to monitor things like AST, ALT, alkaline phosphatase, and bilirubin prior to initiation of therapy monthly for three to four months and frequently thereafter during prolonged treatment periods. We want to use with great caution in patients with liver disease. We want to instruct patients to report signs of liver dysfunction. Antifungals to use in immunocompromised patients: Systemic fungal infection are treated with two classes of agents. Amphotericin B and Azoles (Ketoconazole, Fluconazole) How to treat systemic fungal infections: See above Azoles for 3 weeks -3 months. Amphotericin B IV admin only daily or OD for 6-8 weeks. Ketoconazole and omeprazole concurrently: Reduces absorption of azole. Omeprazole should be admin 1 hrs prior or 2 hrs after azole. PIP have a prolonged duration of action, pts using this drug may have insufficient stomach acid for absorption, regardless of when PIP was given. o What does the patient need to know? Enterobius vermicularis o What is it and who would you expect to have it? (Nematodes) Pinworm, official name is Enterobius Vermicularis. Enterobiasis is the most common helminthic infestation in the United States. Adult pinworms inhabit the ileum and large intestine. Their life span is approximately 2 months. Although usually asymptomatic, some patients experience intense perianal itching. Itching leads to the most common mode of transmission. Pinworm eggs deposited in the perianal are transferred to scratching fingers. If hands are not washed well immediately, the eggs can be transferred to everything the person touches. Drugs of choice are albendazole, mebendazole, and pyrantel pamoate. Because enterobiasis is readily transmitted, all family members of an infected individual should be treated simultaneously.
Notes:
Voriconazole can interact with many drugs. It should not be combined with drugs that
are powerful P450 inducers, including phenobarbital, because these can reduce the
levels of voriconazole
Week 3 Excessive cerumen in ear o Causes: Often d/t cleaning and pushing it back o Treatment Irrigation with warm water or saline. Debrox How to treat otomycosis: Thorough cleansing and application of acidifying drops (3-4 x/day for 7 days). If this does not work, an antifungal soln like clotrimazole (Lotrimin) can be applied BID x 7 day. If this fails, an oral antifungal may be needed, Itraconazole or fluconazole. How to treat acute otitis media (general information for both infection and symptoms) Inflammation of the middle ear. May be d/t bacterial or viral infection or from noninfectious causes. Most cases resolves spontaneously. Ear pain, tugging or holding ear in young children, fever vomiting, anorexia, irritability, sleeplessness, and diarrhea may occur. Commonly develops after a viral upper respiratory infection. To diagnose AOM, three elements must be present: (1) acute onset of signs and symptoms; (2) middle ear effusion (MEE) or, if the TM is ruptured, purulent otorrhea; and (3) middle ear inflammation. Observation should occur (management of symptom relief for 48-72 hrs) If symptoms persist or worsens, ABT is started. Non-severe illness treat with Amoxicillin 40-45mg/kg BID, Severe illness treat with Amoxicillin 45mg/kg BID plus clavulanate 3.2 mg/kg BID. o Treatment in pediatric patient (drug and dose per kg found in textbook) Allergic Rhinitis o Monoclonal antibody drug treatment option: Omalizumab (Xolair) is a monoclonal antibody directed against IgE, an immunoglobulin (antibody) that plays a central role in the allergic release of inflammatory mediators from mast cells and basophils. How to treat glaucoma in someone with COPD or asthma Betaxolol, beta 1 selective Latanoprost o Side effects: Heightened brown pigmentation of the iris and eyelid Glucocorticoids o Therapeutic action in allergic reactions: prevents inflammatory response to allergens and thus reduces all symptoms Antihistamines o Mechanism of action: Blocks histamine-1 receptors Cromolyn o Mechanism of action: Prevents release of inflammatory mediators from mast cells. Sympathomimetics o Mechanism of action: Activate vascular alpha-1 receptors and causes vasoconstriction Guaifenesin
salicylism (e.g., hyperpnea, tinnitus, nausea and vomiting, and mental status changes) is indicated. o Isotretinoin (Accutane) Patient education needed: This drug may affect vision in the dark; therefore avoid driving at night if this affects you. • You may sunburn easily; protect skin from sunlight and avoid sunlamps and tanning beds. • Your provider will need you to come in periodically for blood tests and other assessments. • Women who can become pregnant should use two kinds of reliable birth control. Notify your provider if you miss a period. • You cannot donate blood while taking this drug and for 1 month after you stop. • Avoid supplements containing vitamin A. • Avoid alcohol. • Scarring may occur if you have cosmetic skin procedures while taking this drug and up to 6 months after stopping. Avoid waxing, laser therapy, dermabrasion, or similar procedures. • It is important to notify your provider of any new problems that develop while taking this drug. It is especially important to report the following: • Severe headaches, vision changes (other than decreased night vision), vomiting, weakness, or seizures. These may be signs of increased pressure in the brain. • Symptoms of depression or thoughts of harming yourself or others. • Problems obtaining or maintaining an erection. When to prescribe an intranasal glucocorticoid: Intranasal glucocorticoids are the most effective drugs for prevention and treatment of seasonal and perennial rhinitis. Because of their antiinflammatory actions, these drugs can prevent or suppress the major symptoms of allergic rhinitis: congestion, rhinorrhea, sneezing, nasal itching, and erythema in 90% of patients who use them properly. Eight intranasal glucocorticoids are available (Table 63.2). Three of these— budesonide (Rhinocort Aqua), fluticasone propionate (Flonase), and triamcinolone (Nasacort Allergy 24 hours)—are available in the United States without a prescription. All appear equally effective.
Week 4 Which weight loss drug(s) are associated with a suicide risk in children, adolescents, and young adults? Naltrexone/bupropion What would happen if lorcaserin is given with a CYP2D6 substrate? Lorcaserin is an inhibitor of the CYP2D6 isoenzyme of cytochrome P450. When given with CYP2D substrates (i.e., drugs metabolized by CYP2D6 isoenzymes), the serum levels of the substrates can be increased. To decrease the risk for toxicity when both drugs are prescribed, the substrate may have to be prescribed at a lower dose. Which weight loss drugs are DEA scheduled drugs? Lorcaserin (Belviq, Belviq XR), Diethylopropion, Phentermine (Adipex-P, Lomaira, Phentermine/topiramate (Qsymia), Phentermine o On-going monitoring needs with long-term use: Ongoing assessment of cardiac status. Peripheral effects of greatest concern are tachycardia, anginal pain, and hypertension. Accordingly, these drugs should be used with caution in patients with cardiovascular disease. At what BMI level should bariatric surgery be considered? BMI greater or equal to 35 Liraglutide o Baseline data needed: HbA1C, lipids, renal fx, baseline ability for pt or family to admin injections. o Ongoing monitoring/assessment needs HbA1C every 6 months (if stable), more often as needed. Periodic monitoring of triglycerides. Assess for cholecystitis, pancreatitis, depression, and suicidal thoughts. Lorcaserin o Baseline data needed: Assessment to r/o valvular disorders and pulmonary htn o Ongoing monitoring/assessment needs: Cognitive changes. CBC w/diff for s/s if blood dyscrasias. o Patient education needed: Tolerance is common and may be seen in 6 to 12 weeks. If tolerance develops, the appropriate response is to discontinue the drug rather than to increase the dosage. Naltrexone/bupropion o Baseline data needed: Blood glucose, liver fx, renal fx, and mental status. o Patient education needed: Naltrexone will block opioid effect for pain relief. o Ongoing monitoring/assessment needs: Periodic assessment for blood glucose, liver, and renal fx, s/s of depression, anxiety, panic attacks, suicidal ideation, and mania. Phentermine o Baseline data needed: Chem panel o Ongoing monitoring/assessment needs: Periodic monitoring for electrolyte, serum creatine, s/s of acidosis and s/s of depression. How to discontinue phentermine and/or topiramate: If a patient who is taking phentermine and topiramate has not lost 5% of weight by six months, the drugs should be discontinued.
Prescription Writing
On the exam, you will be provided an example of a prescription for you to analyze and
determine what error exists on the prescription. On the midterm, you will receive 2 of
the following 4 possible questions. You will need to be familiar with common doses,
directions for use, indication, and calculations to figure quantity. A calculator will not be
needed or acceptable to use.
Tetracycline: 1000-2000 mg q 6 hrs for Acne Amoxicillin: 40/45 mg/kg BID for AOM Timolol ophthalmic: 0.25%-0.5% 1 gtt qd BID for glaucoma Benzoyl Peroxide Cream: 10% crea; thin film q daily initially then increase to 2-3 x/day PRN for acne In 2020, approximately how many cases of Chlamydia trachomatis infections were reported in the United States? 1,600, 4,750, 250, 725,
In the life cycle of Chlamydia trachomatis , which particle is considered infectious and first infects the host cell? The reticulate body The rectangular body The elongation body The elementary body
A 26-year-old male has two new recent sex partners and presents with urethral discharge. Which one of the following tests is preferred for detecting Chlamydia trachomatis****? Urethral swab for Gram's stain Urethral swab for culture First-catch urine for culture First-catch urine for nucleic acid amplification test (NAAT)
Which one of the following most accurately describes recommendations for chlamydia screening in asymptomatic females? Perform one-time screening in all sexually active females 25-30 years of age Perform one-time screening in all sexually active females 21-25 years of age Perform annual screening in sexually active females 15-20 years of age and in older women who have a prior history of a sexually transmitted disease Perform annual screening in sexually active females 24 years or younger and in older women who are at increased risk for chlamydial infection
A 19-year-old woman has Chlamydia trachomatis detected on a screening test of a self-collected vaginal swab. She has a pregnancy test, which is negative. Which one of the following medication regimens should be used for treatment in this case? Amoxicillin 500 mg orally three times daily for 3 days Azithromycin 500 mg orally once daily for 7 days Doxycycline 100 mg orally twice daily for 7 days Levofloxacin 250 mg orally once a day for 5 days Which one of the following statements is TRUE regarding the epidemiology of gonococcal infections in the United States? Rates of reported cases have decreased significantly in recent years Among different age groups, rates of reported cases are highest in those 35-39 years of age Oregon is the state with the highest rate of reported cases Rates of reported cases are higher in males than in females
Based on data from the Gonococcal Isolate Surveillance Project (GISP), which one of the following statements is TRUE? In recent years, more than 15% of gonococcal isolates have reduced susceptibility to azithromycin (defined as MIC ≥2 μg/mL) In recent years, more than 10% of gonococcal isolates have been resistant to ciprofloxacin In recent years, the percentage of isolates with reduced susceptibility to ceftriaxone (defined as MIC ≥0.125 μg/mL) has been approximately 12% In recent years, approximately 15% of gonococcal isolates have reduced susceptibility to cefixime (defined as MIC ≥0.25 μg/mL)
A 19-year-old man is evaluated in the clinic with a purulent urethral discharge. A Gram's stain is performed on a sample of the discharge. Which one of the following is most consistent with a diagnosis of gonorrhea? Extracellular gram-positive cocci in chains Abundant white blood cells with no visible organisms
Late latent syphilis refers to syphilis infection of at least 1 year in duration Late latent syphilis refers to syphilis infection of at least 6 months in duration Late latent syphilis refers to syphilis infection of at least 6 weeks in duration Late latent syphilis refers to syphilis infection of at least 12 weeks in duration
A 24-year-old man presents to a clinic with a diffuse macular and papular rash on his chest, back, hands, and feet. He had two new male sexual exposures approximately 6 weeks ago. He now has a positive Venereal Diseases Research Laboratory (VDRL) test with a titer of 1:256. He had a negative syphilis test about 3 months ago. He has no other symptoms and his neurologic examination is normal. He has no known antibiotic allergies. What treatment is indicated? Benzathine penicillin G 2.4 million units IM weekly for 3 total doses Benzathine penicillin G 2.4 million units IM in a single dose Doxycycline 200 mg twice a day for 3 days Ceftriaxone 250 mg IM in a single dose plus azithromycin 1 g orally in a single dose
A 41-year-old man with HIV presents with headaches and new hearing loss. He has a positive serum Venereal Disease Research Laboratory (VDRL) test with a titer of 1:64. A lumbar puncture is performed and shows 43 white blood cells/mm^3 and a cerebrospinal VDRL titer of 1:32. He does not have any antibiotic allergies. What treatment should be recommended for this man? Doxycycline orally 100 mg twice daily for 7 days Ceftriaxone 1 gram IV daily for 3 days Aqueous crystalline penicillin G 18–24 million units per day, administered as 3–4 million units IV every 4 hours or continuous infusion, for 10–14 days Ceftriaxone 1 gram IV twice daily for 7 days Based on data from the National Health and Nutrition Examination Survey (NHANES) collected in 2015-2016, which one of the following is TRUE regarding trends in seroprevalence of herpes simplex virus-2 in the United States? The rates decreased for four years and then increased The rates have steadily increased The rates have steadily decreased The rates have stayed almost the same
How is most genital HSV-2 transmitted? During the initial 72 hours of a recurrent symptomatic infection During asymptomatic viral shedding
During the wet ulcer phase of a recurrent symptomatic infection During a rebound viral activation phase that occurs following discontinuation of antiviral therapy for recurrent symptomatic infection
Which one of the following statements best describes recommendations regarding routine serologic screening for genital herpes infection in asymptomatic adolescents and adults? Routine screening is not recommended It is recommended for all sexually active men ages 18 to 30 years It is recommended for all pregnant women younger than 35 years of age It is recommended for all sexually active women ages 18 to 30 years
A 38-year-old man is evaluated in a clinic for an episode of recurrent genital herpes. He is in good health and does not have HIV. Which one of the following treatment options would be considered a recommended regimen for recurrent genital herpes? Valacyclovir 500 mg orally twice a day for 3 days Acyclovir 400 mg orally once a day for 3 days Acyclovir 800 mg orally as a single dose Valacyclovir 1000 mg orally as a single dose
Which one of the following regimens has been shown to reduce transmission of HSV in heterosexual HSV-2 discordant heterosexual couples? Acyclovir 800 mg orally once daily taken by the HSV-seronegative partner Famciclovir 250 mg orally once daily taken by the HSV-seropositive partner Famciclovir 500 mg orally once daily taken by the HSV-seronegative partner Valacyclovir 500 mg orally once daily taken by the HSV-seropositive partner Which one of the following statements is TRUE regarding the risk of pelvic inflammatory disease (PID) associated with use of an intrauterine contraceptive device? The risk of PID decreases during the first 18 months after insertion of the intrauterine contraceptive device The increased risk of PID is primarily confined to persons who maintain the same intrauterine contraceptive device for more than 2 years There is no correlation of PID with use of an intrauterine contraceptive device The increased risk of PID is primarily confined to the first 3 weeks after insertion of the intrauterine contraceptive device
Wet mount showing abundant bacterial clumping upon the borders of vaginal epithelial cells and vaginal pH greater than 4. Wet mount showing motile gyrate bacteria and vaginal pH less than 4. Gram's stain showing predominance of gram-positive rods and vaginal pH less than 4. Overgrowth of Lactobacillus species on vaginal specimen culture and vaginal pH less than 4.
A 29-year-old woman with a malodorous, homogenous gray vaginal discharge is diagnosed with bacterial vaginosis. She is not pregnant. What is the recommended treatment for this woman? Metronidazole 2 grams orally as a single dose Doxycycline 100 mg twice a day for 7 days Metronidazole 500 mg orally twice a day for 7 days Clindamycin 450 mg three times a day for 7 days
A 26-year-old man is diagnosed with trichomoniasis. Which one of the following regimens is the preferred treatment for this man? Metronidazole 500 mg orally as a single dose Metronidazole 2 grams orally as a single dose Azithromycin 250 mg orally once daily for 5 days Tinidazole 2 grams orally daily for 3 days
Which one of the following statements is TRUE regarding trichomoniasis and HIV? The preferred therapy for trichomoniasis in women with HIV is tinidazole 2 g orally as a single dose Active infection with Trichomonas vaginalis confers a two- to three-fold risk of acquiring HIV infection The preferred therapy for trichomoniasis in women with HIV is metronidazole 2 g orally as a single dose Active infection with Trichomonas vaginalis activates CD8 cells and confers a three-fold lower risk of acquiring HIV infection
A 30-year-old woman is 28 weeks pregnant and presents with severe vulvar itching and burning, along with thick, white, clumpy vaginal discharge. Which one of the following is a recommended regimen for this woman? Fluconazole 150 mg orally once daily for 7 days Clotrimazole 2% cream 5 grams applied intravaginally as a single dose Clotrimazole 1% cream 5 grams applied intravaginally daily for 7 days Fluconazole 150 mg orally in a single dose
