APEA 3P EXAM PREP2 –SEXUAL HEALTH WITH RATIONALE

APEA 3P EXAM PREP2 –SEXUAL HEALTH WITH RATIONALE A 24-year-old female presents with abdominal pain. What additional finding supports a diagnosis of pelvic inflammatory disease (PID)? Dysuria Vaginal discharge Positive RPR Cervical motion tenderness - D. PID is difficult to diagnose and often goes unrecognized because of the varied presenting signs and symptoms in women who have it. Delay in diagnosis contributes to inflammatory sequelae in the upper reproductive tract. Consequently, PID is usually diagnosed on imprecise clinical findings. The CDC recommends that healthcare providers maintain a low threshold for diagnosis of PID. Presumptive treatment should be initiated in sexually active women if they are experiencing pelvic or low abdominal pain (without another identifiable source of illness), and if one or more of the following criteria are present on pelvic exam: cervical motion tenderness, uterine tenderness, or adnexal tenderness. A male patient presents with dysuria and penile discharge. He states that his female partner has an STD, but he is not sure which one. Which of these should be part of the differential? Bacterial vaginosis and trichomonas Chlamydia and gonorrhea HIV and herpes Syphilis and chlamydia - B. Bacterial vaginosis and HIV are not associated with dysuria or penile discharge in male patients. Herpes produces lesions that are painful. HIV is not specifically associated with dysuria. Syphilis produces a painless lesion. Chlamydia and gonorrhea are usually associated with dysuria and discharge. Trichomonas is often asymptomatic in males, but can produce dysuria. A patient being treated for trichomoniasis receives a prescription for metronidazole. What instructions should she be given? Take this medication with food Do not take this medication if you are pregnant Take this medication on an empty stomach Alcohol should be avoided when taking this medication - D. Metronidazole may be associated with a disulfiram reaction when mixed with alcohol. Advice that should be given to all patients who take metronidazole is to avoid alcohol entirely while this medication is being taken. Additionally, alcohol should be avoided for 24 hours after the last dose of medication. The disulfiram reaction is characterized by fever, abdominal pain, nausea, vomiting, and headache. This reaction is called the "Antabuse" reaction. The risk of HIV transmission is increased: when other STDs are present. in females. when patients are aware of their HIV status. in patients with diabetes. - A. There are several risk factors for HIV transmission. Viral load is likely the greatest risk factor. The presence of STDs increases the risk of HIV transmission. Specifically, the presence of chlamydia increases the risk of acquiring HIV by 5 times. Lack of circumcision increases the risk of transmission. A patient requests screening for HIV after a sexual exposure. What are CDC's recommendations for screening for this patient? There are no recommendations for screening. She should be screened today, with repeat screening at 4-6 weeks, and 3 months. She should be rescreened in 6-12 months She only requires screening if she develops symptoms of HIV - B. She does require further screening because a negative initial result does not insure that she is not infected. This signifies that she has not seroconverted at this time. The period within 3 months after exposure is termed the "window period" and a negative screen must be confirmed. If a 4th generation assay is used and the screen is negative 3 months after the last exposure, and there is no concern for coinfection with hepatitis C at the time of HIV exposure, she is considered to be negative. HIV screening should be performed in any patient who develops symptoms consistent with HIV after an exposure. A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what test should be performed? HIV test RPR Lymph node biopsy Sedimentation rate - A. During asymptomatic HIV infection, patients often have persistent generalized lymphadenopathy (PGL). PGL is defined as enlarged lymph nodes involving at least two noncontiguous sites other than inguinal nodes. The lymphatic tissue serves as a primary reservoir for HIV. Studies of lymph nodes in patients at the asymptomatic phase demonstrate high concentrations of HIV. A 23-year-old female who is homeless presents to the free clinic. She should be screened for: TB, HIV, and hepatitis. pregnancy, headaches, and STDs. urinary tract infection and STDs. diabetes, HIV, and neuropathy. - A. The most common diseases in the homeless population are not seen in the same proportion in the general population. These include hepatitis, HIV, STDs, pregnancy in females, TB, skin and foot problems, and late immunizations, especially tetanus. When given the opportunity, screenings and treatment should take place when appropriate. A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulval itching and discharge. He is asymptomatic. How should they be treated? She should receive metronidazole; he does not need treatment. They both should receive metronidazole. She should be treated with ceftriaxone; he should receive ciprofloxacin