peraspera
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A 28-year-old woman comes to your clinic for vaginal discharge and dyspareunia. Her last pelvic exam and Pap smear six years ago were normal. Her only medication is oral contraceptives. She is sexually active with one partner and denies a history of sexually transmitted diseases. Examination of the pelvis reveals a mucopurulent, nonodorous, whitish discharge at the endocervical os. The cervix appears edematous and erythematous with minimal bleeding noted with scraping. What is the next appropriate step in the management of this patient?
(A) Doxycycline
(B) Azithromycin and ceftriaxone
(C) Metronidazole
(D) Wait for culture and immunofluorescence testing results
(E) Azithromycin
A 43-year-old man who recently relocated to your area presents with four months of blood in his urine, cough, weight loss, and low-grade fever. The physical examination is remarkable for nasal deformity and otitis media. A C-ANCA test is positive. What is best initial therapy for this patient?
(A) Methotrexate
(B) Prednisone
(C) Cyclophosphamide
(D) Prednisone and cyclophosphamide
(E) Trimethoprim/sulfamethoxazole
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| elitoki
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1.E
Chlamidya
2. D
This is Wegener Granulomatosis.
peraspera! what is similar between them???? I don't see any relationship btw two Qs.
Edited by elitoki on 09/14/07 - 02:58 PM
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| Kamsi
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1 B
Cervicitis
2 D
Wegener's granulomatis
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| peraspera
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The q about STD is similar to q from Sept.12 HY, but there is a difference.
Sorry for confusing name of the post.
Edited by peraspera on 09/14/07 - 03:44 PM
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| dr in trouble
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1--E Cervicitis
2--D
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If u want to do something, do it today as there is no tomorrow.
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| peraspera
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1. (B) Azithromycin and ceftriaxone
Explanation:
This patient presents with cervicitis and a mucopurulent discharge found on pelvic exam. The presence of white blood cells is also often found on endocervical Gram stain, which would also support the diagnosis. This is too nonspecific to be useful in guiding the choice of a single specific therapy. All forms of cervicitis will give white cells on a Gram stain of the cervix. Edema of the cervix with the propensity of the mucosa to bleed on minor trauma is common with cervicitis. These findings are commonly found in association with both chlamydial and gonococcal infection. Empiric therapy for both diseases is indicated. You can't just treat the chlamydia. This patient has a clear diagnosis of cervicitis because of the discharge and dyspareunia, combined with a cervical discharge. Chlamydia can be treated either with a single dose of azithromycin or with doxycycline for a week in those patients with cervicitis or urethritis. Gonorrhea can be treated with a single dose of ceftriaxone, cefixime, or a fluoroquinolone, such as ciprofloxacin, levofloxacin, or ofloxacin. The quinolones are associated with more resistance than the cephalosporins.
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| elitoki
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I was confused after your answer. but UW said that when you have Chlamidia you treat just this, and it is not necesary to treat Gonorrhea.
When you treat empirically Gonorrhea you should treat for Chlamidia, too.
Now, in this Q. didn't say any specific "word" for dx gonorrhea, or is there?
In case of non -specific symptom... Chlamidia is the most freq cervicitis, so my answer was E.
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| peraspera
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elitoki, Blueprints OB/GYN, the treatment in the book is the same as in this case:-cefriaxone 250mg IV (once)+ doxy 100mg (orally) for 1week, or isteed doxy, azithromycin 1g. This question is from Internal Med.,by Conrad Fischer.
In the question from Sept.12 ( UW) -there is a difference, A gram stains of the discharge reveals greater than 30 WBC/HPF and absence of organism, so if we don't see gram-negative diplocc. we can't give c efriaxone, we only will treat
Chlamidia with azithromycin.
We really need to be very careful with tricky questions.
This is why I wrote-similar but different
In the UW q- Answer: Chlamidia ( Azithromycin)
In C.Fischer q-: Gonorr.+Chlamidia (Cefriax+Azithr.)
Edited by peraspera on 09/15/07 - 07:10 PM
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| usmle-china
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I agree with peraspera.
In this case, the dignosis is Cervitis. However, the question stem didn't provide gram stain or other specific measurement. You cannot exclude Gonorrhea. You need to treat both Gonorrhea and Chlymydia. Thta is why a single dose of ceftriaxone ( for Gonorrhea ) and Azithromycin ( for Chlymydia ) are necessary.
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| starcraftbw
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treat both....
why do you add cyclophosphamide in W G disease?
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| peraspera
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#2. (D) Prednisone and cyclophosphamide
Explanation:
Wegener's granulomatosis is characterized by granulomatous vasculitis of the upper and lower respiratory tract and kidneys. The most definitive diagnosis is by biopsy of the lung or upper respiratory tract. C-ANCA is very sensitive and specific in detecting the disease but is not sufficient alone to establish a diagnosis. The most effective treatment for the disease is prednisone combined with cyclophosphamide. The steroids should be tapered after one month to alternate day dosing and eventually stopped. The cyclophosphamide should be continued for one year. Cyclophosphamide can cause cystitis, bladder cancer, and myelodysplasia. The alternate therapy for those who develop serious toxicity is methotrexate combined with prednisone. Methotrexate leads to remission in many patients. Trimethoprim/sulfamethoxazole is helpful in maintaining patients in remission but is not useful in those with serious, life-threatening disease. ( IM by Conrad Fischer)
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