HY lecture notes:
If you get Q with a girl who presents with dysuria / UTI-like Sx but has completely normal urinalysis, the answer = screen for chlamydia.
Answer to decrease recurrence of UTIs = postcoital voiding. If this has been attempted but she continues to develop UTIs, the next best answer = postcoital nitrofurantoin prophylaxis.
However the caveat is, if the Q mentions that she has been treated successfully in the past for UTI with TMP/SMX, the answer will simply be TMP/SMX instead of nitrofurantoin.
If postcoital prophylactic Abx have been attempted yet she still develops UTI, the next answer is daily TMP/SMX prophylaxis. Sounds outrageous and overkill, but it’s an answer on one of the obgyn NBME forms.
Bacterial vaginosis + trichomoniasis are both diagnosed with wet mount.
BV –> thin grey / watery discharge +/- vulvar irritation –> visualize clue cells on wet mount. Tx with topical metronidazole gel.
Trichmoniasis –> yellow/green discharge + strawberry cervix (punctuate hemorrhages) or erythematous vaginal canal –> visualize flagellated protozoa on wet mount. Tx with topical metronidazole for patient and partner.
Tx for syphilis –> penicillin. If Hx of anaphylaxis to penicillin, give doxycyline if primary syphilis. If secondary, tertiary, neurosyphilis, or if the patient is pregnant, the answer = desensitize + give penicillin.
Tx for chlamydia + gonorrhea on USMLE / shelf always = cotreatment with IM ceftriaxone + oral azithromycin or doxycycline. Gonococcus is notoriously difficult to detect, so if a patient has mucopurulent discharge + no organisms visualized, we still give IM ceftriaxone for gonococcal coverage (in addition to the chlamydial coverage) because we might not detect the gram (-) diplococci.
Treatment for immune thrombocytopenic purpura (ITP) is steroids first, then IVIG, then splenectomy –> steroids is always the first answer –> splenectomy is the answer if they ask for which is most likely to decrease recurrence.
