Normal Flora & Disruption
Diagnostic Tools
Antibiotic Basics
Pathogens & Patterns
Resistance & Pitfalls
Rapid Fire Clinical Scenarios
100
Gram-positive rods dominating vaginal smear
What is Lactobacillus?
100
First-line test for gonorrhea and chlamydia
What is NAAT (nucleic acid amplification test)?
100
Antibiotic class for treating chlamydia
What is macrolide (azithromycin) or tetracycline (doxycycline)?
100
Most common cause of vulvovaginal candidiasis
What is Candida albicans?
100
Mechanism of antibiotic resistance via enzyme production
What is beta-lactamase?
100
Thin gray discharge + fishy odor + pH >4.5
What is BV?
200
This specific metabolic byproduct of Lactobacillus species is primary in maintaining a normal vaginal pH of 3.8 to 4.5, effectively inhibiting the overgrowth of syndromic anaerobes.
What is lactic acid production?
200
Classic BV diagnostic criteria
What are Amsel criteria?
200
Mechanism of beta-lactam antibiotics
What is cell wall synthesis inhibition?
200
Organism causing “strawberry cervix”
What is Trichomonas vaginalis?
200
Why gonorrhea treatment guidelines frequently change
What is rapid resistance development?
200
Frothy green discharge + motile organisms
What is Trichomoniasis?
300
Condition caused by loss of Lactobacillus and overgrowth of anaerobes
What is bacterial vaginosis (BV)?
300
These epithelial cells have borders obscured by bacteria
What are clue cells?
300
Antibiotic used for BV
What is metronidazole?
300
Classic PID pathogens
What are gonorrhea, chlamydia, anaerobes?
300
Risk of treating BV incorrectly
What is recurrence or persistent dysbiosis?
300
Pelvic pain + cervical motion tenderness
What is PID?
400
Two risk factors that disrupt normal vaginal flora
What are antibiotics, douching, new sexual partners, estrogen deficiency?
400
**
Motile, flagellated organisms but the test sensitivity is only ~50–60%
What is the next best test?
What is NAAT for Trichomonas?
400
Why metronidazole works for BV
What is anaerobic coverage?
400
Post-hysterectomy cuff infection organisms
What are polymicrobial (gram-negative + anaerobes)?
400
Biofilms contribute to this clinical issue
What is recurrent BV?
400
Thick white discharge + itching + normal pH
What is Candida vaginitis?
500
Why BV increases risk of post-op infections
What is polymicrobial anaerobic overgrowth leading to ascending infection?
500
Why cultures are limited for chlamydia
What is obligate intracellular organism → difficult to grow?
500
**This property determines whether an antibiotic’s effectiveness depends on peak concentration vs duration above MIC.
What is pharmacodynamics (time-dependent vs concentration-dependent killing)?
500
Organism associated with toxic shock syndrome
What is Staphylococcus aureus?
500
Why broad-spectrum antibiotics can worsen yeast infections
What is disruption of normal flora → Candida overgrowth?
500
**A patient with PID requires treatment that covers gonorrhea, chlamydia, AND this additional microbiologic group.
What organisms must also be covered?
What are anaerobes?