Escolar Documentos
Profissional Documentos
Cultura Documentos
Page 4
BENIGN PROSTATIC HYPERPLASIA
Now seeing more BPH because people are living longer.
Nodular gland is not necessarily cancerous: this happens in any enlarged organ that is encapsulated.
GONORRHEA
• Sex + opaque urethral discharge. Take history. Swab, stain, culture the discharge.
• Not limited to men: affects women too.
• Multiple sex partners: risk factor, but not limited to sexual interaction.
• Patient will come in because of pain during urination, not because of discharge.
• May become chronic, pain will lessen over time. These patients may be incubating and spreading the illness without
treating it.
• Patient will have fever, increased WBC count.
CHLAMYDIA
• Sticky, watery discharge. Mucousy, clear discharge. Still contains some WBC, but not as much as gonorrhea.
• Causes trachoma in childbirth: blindness
• Difficult to urinate in the morning, mucous obstructs urethra.
• Sore throats may be the result of sexually transmitted disease from oral sex
• Females may be asymptomatic.
• Progression: starts as discomfort, this may be ignored, then it moves into chronic case.
• Associated with infertility in women: fibrosis in fallopian tubes.
HERPES
• Tends to affect area that it first came in contact with the body.
• In neonates, causes meningitis, (in everyone?) causes renal complications, septicemia and death. Not just cold
sores.
• Vesicles. Unique presentation. Tzank smear: almost never required because of presentation. History + fluid filled
vesicles + pain… not much else it could be.
• Herpes lives in nerves, expressed in vesicles.
• Contagious before vesicles burst. May spread to other nerve endings in vicinity during outbreak (autoinfection)
• The virus does not die. Immune system allows it to continue living.
• Can lead to erosions, loss of skin. PAIN.
• Most transmissions occur when there are no visible lesions.
• Sex education should begin very early!
• HSV I tends to cause: encephalitis, conjunctivitis, gigivostormatitis tonsillitis labialis, pharyngitis esophagitis, herpes
gladiatorum, tracheobronchitis, genital herpes, herpes whitlow.
• HSV II tends to cause meningitis, gingivostomatitis tonsillitis labialis, pharyngitis, perianal herpes, genital herpes,
herpes whitlow.
• PRODOMAL ITCHING AND TINGLING: this is vesicles forming: skin is detaching from dermatome.
• Not many DDxs, but add chicken pox to list.
• Primary and secondary lesions are different.
• Manage through lifestyle, managing stressors
• Immunocompromised patients: different presentation. More likely to progress from cold sore to more systemic effects.
CONDYLOMA ACUMINATA
• No erythema, no pain. Flesh-coloured mass.
• In feet, plantar wart, can be painful as you are walking on it all day.
• Less well-circumscribed on mucous membranes. Can be tiny patches (in slide at vagina)
• During pregnancy, immune system is suppressed: condyloma can take over.
• Molluscum contagiosum: ddx. This is an umbilicated growth. See this in pediatric cases.
SYPHILIS
• Angry-looking sore. Tends to be large, surrounded by redness. Patient feels nothing: this is pathognomonic. Not
herpes, not acne… No pain felt because syphilis affects the nerves.
• Hard, solitary, painless sore. UNMISTAKABLE. Would have painless lymphadenopathy.
• Rash on palms and soles: look for this.
• Condyloma lata: can be mistaken for fungal infection: causes hair loss.
• Tertiary syphilis: Gumma. Immune system is waking up. Covers offending cells with fibrous tissue. Causes lots of
problems throughout the body.
• Know syphilis well for NPLEX
• VDRL, RPR; if these don’t come back +, need help of specialist. More specialized tests that we can’t order.
CHANCROID
• Like painful primary syphilis. If you have a nodule that looks syphilitic, but is PAINFUL, consider chancroid.
• Much less serious than syphilis.
Evaluation: is it sexual desire (psychogenic), erection, orgasm difficulty (may be psychogenic or functional, more likely to
be psychogenic)?
This page will be sent to us will answers filled out!
•
DDX LECTURE 36, FEBRUARY 28th, 2007 – PAGE 2
DDX LECTURE 36, FEBRUARY 28th, 2007 – PAGE 3