Vaginitis

Vaginitis
* pathophysiology
* etiology
* diagnosis
* treatment

The dynamic vagina
* vaginal secretions, exfoliated cells, cervical mucosa
* lactobacillus acidophilus
* estrogen
* glycogen
* vaginal pH
* metabolic byproducts of flora and pathogens

Causes of vaginitis
* antibiotics
* contraceptives
* sexual intercourse
* douching
* stress
* hormones
* allergies and chemical irritation

Bacterial vaginosis
* proliferation of Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, Peptostreptococcus species
* most common cause
* 1/3 to 2/3 asymptomatic
* 15 to 19% of all women
* 10 to 30% pregnant women

BV misc.
* role of sexual transmission unclear
* risk for preterm labor and PROM
* increased frequency of abnl PAPs, PID, endometritis
* Sxs: profuse malodorous discharge
* Exam: thin grayish discharge, seldom vaginal or vulvar irritation

Risks associated with BV
* Early sexual ‘debut’
* new or multiple sex partners
* IUD (50% contract it over 2y)
* OCP
* Lesbians/receptive oral sex
* no RCT’s but association with douche, c-section and around time of menses

Amsel’s criteria
* thin, homogenous discharge
* positive “whiff” test
* “clue cells” present on microscopy
* vaginal pH > 4.5

BV treatment
* metronidazole 500 mg BID x 7 days
* clindamycin 2% cream qhs x 7 days
* metrogel 0.75% BID x 5 day (vs. QD)
* metronidazole 250 mg TID x 7 days
* metronidazole 2 g po single dose
* metrogel (no previous PTL)

Vulvovaginal Candidiasis
* second most common in U.S.
* Candida albicans predominates
* increasing frequency of non-albicans species (C. glabrata)
* Risks: OCPs, diaphragm, IUD, early intercourse, >4X/month, receptive oral sex, diabetes, recent antibiotics.
* endogenous vaginal flora in 50% women
* not sexually transmitted nor related to number of sexual partners
* treatment of male partner of no benefit
* c/o pruritis, vaginal irritation, dysuria
* vulvovaginal itching not normal in healthy women (lichen sclerosis, vulvar cancer)
* exam: thick white discharge, no odor, normal pH
* vulvar and vaginal erythema

diagnostics
vulvovaginal candidiasis Rx
Trichomoniasis
Evaluation
Trich treatment
Atrophic Vaginitis
Other considerations

Vaginitis.ppt

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VASCULITIS SYNDROMES

VASCULITIS SYNDROMES
By:Emily B. Martin, MD
Rheumatology Board Review

KAWASAKI SYNDROME
Mucocutaneous lymph node syndrome
KAWASAKI DISEASE
* Diagnostic criteria:
CLINICAL MANIFESTIONS
* Arthritis and arthralgia
* Urethritis
* CNS involvement
* GI symptoms

DIFFERENTIAL DIAGNOSIS
* Viral infections
* Toxin mediated illnesses
* Rickettsial or spirochete infections
* Drug reactions
* JRA
* Mercury hypersensitivity reaction

LABORATORY EVALUATION
* Markers of systemic inflammation
* Anemia (normocytic, normochromic)
* Sterile pyuria (urethral origin, don’t do a cath)
* Transaminase elevation (mild to moderate)
* CSF findings
* Synovial fluid inflammation
* Hyponatremia (increased risk for coronary aneurysms)

TREATMENT
* Mainstay of treatment is IVIG 2 gram/kg over 8-12 hours.
* IVIG may need to be repeated in refractory cases.
* Several studies have shown that IVIG + aspirin decreases the risk of coronary aneurysms compared to aspirin alone.
* High dose aspirin during acute illness then low dose for about 2 months.

FOR THE BOARDS…
* Know the clinical manifestations of Kawasaki syndrome.
* Know the differential diagnosis of KD.
* Know the laboratory abnormalities seen in KD.
* Recognize the value of high-dose IVIG in treatment of KD.

QUESTIONS
HENOCH-SCHONLEIN PURPURA

* Most common systemic vasculitis in children.
* Immune mediated
* Often a self-limited disease.
* Occurs more often in fall, winter, and spring.
* About 50% of cases are preceded by URI’s.

CLINICAL PRESENTATION
* Classic tetrad
GI SYMPTOMS
* HSP can cause edema and submucosal hemorrhage of GI tract.
* May be the presenting symptom of HSP.
* Symptoms typically develop within 8 days of the rash.
* Intussusception is the most common GI complication.

RENAL DISEASE
* Occurs in up to 50% of patients.
* Ranges from hematuria to end-stage renal disease (<1% of patients).
* Usually presents within four weeks of onset of HSP.
* Overall prognosis is very good, but there is some long-term risk of progressive renal impairment.

LABORATORY FINDINGS
* There is NO definitive diagnostic test.
* IgA levels may be elevated in 50-70% of patients.
* Platelet counts and coag studies should be normal.
* Inflammatory markers may be elevated.
* Urinalysis
* Negative RF and ANA.
* Recognize the typical presentation of HSP.
* Recognize that HSP may present initially with ABDOMINAL PAIN OR JOINT COMPLAINTS.
* Know the typical laboratory findings in HSP.

MOST likely diagnosis is
* Henoch-Schonlein purpura
* Immune thrombocytopenic purpura
* Juvenile rheumatoid arthritis
* Parvoviral infection
* Post-streptococcal arthritis

VASCULITIS SYNDROMES.ppt

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Pharmacology Review of Everything

Pharmacology Review of Everything 2003-2004

Abacavir
Antiretroviral
Nucleoside reverse transcriptase inhibitor (NRTI)

Abciximab
Antiplatelet
Anti-GPIIb/IIIa receptor antibody

Acarbose
Oral hypoglycemic
Alpha-glucosidase inhibitor
Inhibitor of intestinal glucose absorption

Acebutolol
Sympatholytic
1 adrenergic antagonist
Class II antiarrhytmic

Antihypertensive
Antianginal
Bronchoconstrictor

Acetaminophen
Analgesic, Antipyretic

Acetazolamide
Diuretic
Carbonic anhydrase inhibitor


Acetylcholine
Cholinomimetic
Antigluacoma
Muscle contraction (nicotinic receptor)

Activated charcoal
Antidote

Acyclovir
Antiherpes
Purine analog
Phosphorylated to inhibitor of viral DNA polymerase

Adenosine
Antiarrhythmic
Miscellaneous
(does not fit class I-IV organization)

Adrenocorticotropin
(ACTH)
Anterior pituitary hormone
Anticonvulsant

Stimulates synthesis
and release of cortisol


Albendazole
Antihelminthic
Treatment of intestinal roundworms

Albuterol
Sympathomimetic
2 adrenergic agonist
Short acting bronchodilator
Used in asthma

Aldosterone
Adrenocorticosteroid
Mineralocorticoid

Alemtuzumab
Antineoplastic
Anti-CD52 antibody

Alendronate
Anti-osteoporesis

Bisphosphonate
Inhibitor of osteoclast-mediated bone resorption

Alfentanil
Opioid
General anaesthetic
Intravenous anaesthetic

Allopurinol
Antigout
Antineoplastic (supporting agent)

Folic acid analogue
Xanthine oxidase inhibitor


Alteplase
Thrombolytic
Tissue plasminogen activator (tPA)

Aluminum hydroxide
Antiulcer
Antacid

Amantadine
Antiviral
Antiparkinson

Treatment of Influenza A
Inhibits replication
at the stage of uncoating

List goes A-Z. This is very exhaustive presentation.

Pharmacology Review of Everything 2003-2004

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