Christa presents to the clinic c/o spotting and pain after sexual relations. She reports
that her cycles are regular, however they have become longer and painful. She is
sexually active and reports having 2 sexual partners within the past year and not using
any form of birth control. Based on these findings, what would the NP test for? -
ANSWER Chlamydia, gonorrhea, syphilis
You test Christa for STI's. She is positive for chlamydia. What do you treat her with. She
has no allergies. - ANSWER Azithromycin 1 gram. Take 1 tab po as a single dose.
What would you treat Christa with if she was allergic to the first line of choice for
chlamydia? - ANSWER doxycycline (tetracycline). take 1 tab po bid X 7 days.
It is important for Christa to have her partners treated for chlamydia. How long will
Christa have to wait before resuming intercourse after being treated? - ANSWER 7 days
post treatment.
How long should Christa wait before returning for a follow up visit after her chlamydia
treatment? She is not pregnant. - ANSWER 3 months, but sooner if symptoms do not
resolve.
At what age should ALL women be tested for STI's such as chlamydia and gonorrhea? -
ANSWER All women 25 and younger annually if sexually active.
Christa is 35 and has multiple partners, both male and female. Should she be tested
annually for STI's? - ANSWER Yes, any women 25 and older with risk factors should be
tested annually.
The NP is seeing Dylon for her annual exam. Dylon is due her PAP test. The NP notices
purulent cervical discharge and swelling in her labia. Upon the bimanual exam Dylon
complains of slight tenderness when the NP checks her adnexa. No other symptoms
, exist. Dylon has not been sexually active for 3 months. She does not use any form of
contraception and has no health problems. What should the NP test for? - ANSWER
STI's. This could be gonorrhea. Screen for chlamydia, syphilis, and HIV, too.
The NP now proceeds to see the next patient. The patient presents for a STI work up. In
what sequence should the NP perform her examination workup? - ANSWER 1. Vital sign.
Especially temp to r/o PID
2. Skin for DGI (disseminated gonococcal infections)
3. Back of throat
4. Cervical lymphadenopathy
5. Abdomen: palpate for masses, tenderness, rebound pain (r/o PID)
6. Speculum exam: describe walls of vaginal, ectopy (cervix protruding), and friability
7. Collect specimens for gc, cz, syphilis, and HIV
8. Bimanual
The NP receives the NATT test result back for POSITIVE gonorrhea. What is the first line
of treatment for gonorrhea? - ANSWER Rocephin 250mg IM X 1 dose in office.
If your patient is allergic to Rocephin or refuses to have an injection, what should the NP
order for the treatment of gonorrhea? - ANSWER Cefixime (cephalosporin) 400mg po X1
dose
Brenda is pregnant and tests positive for chlamydia (cz) and gonorrhea (gc). You treat
Brenda appropriately. Should Brenda come back for a follow up visit? If so when? -
ANSWER Yes. She should return for test-of-cure in 3 weeks.
Paula is in the ER and you receive a call to see her. After talking with Paula she admits
she has been feeling bad for 2 weeks. She reports sever abdominal and low back pain, a
virginal discharge, urine frequency, and she can't hold anything down. Paula has been
ruled out as having appendicitis and kidney stones. Her chart indicated she had an
abortion 1 month ago. Her temp is 101.5. What would you suspect? Why? - ANSWER
PID. Her temp and her 1 month post abortion.
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