Master the board step 3

Master the Boards: USMLE Step 3
Basic Science Correlate
Mechanism of Infertility and Ectopic Pregnancy in PID
The tubes become scarred and narrowed. Sperm cannot travel in to fertilize
the egg. Fertilized eggs get caught and implant in the wrong place—all from
loss of ciliary action, fibrosis, and occlusion.
Antibiotics that are safe in pregnancy:
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Penicillins
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Cephalosporins
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Aztreonam
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Erythromycin
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Azithromycin
Epididymo-Orchitis
Presents with an extremely painful and tender testicle with a normal position
in the scrotum. Testicular torsion is different, because it presents with an
elevated testicle in an abnormal transverse position.
Treatment
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< 35 years of age: Ceftriaxone and doxycycline
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> 35 years of age: Fluoroquinolone
Ulcerative Genital Diseases
All forms of ulcerative genital disease can be associated with enlarged lymph
nodes. Sexual history is not as important as the presence of ulcers.
Chancroid
The ulcer will be painful (Haemophilus ducreyi).
Diagnostic Testing
The best initial test is a swab for Gram stain (gram-negative coccobacilli) and
culture (will require specialized medium: Nairobi medium or Mueller-Hinton
agar).
Treatment
Single IM shot of ceftriaxone or single oral dose of azithromycin.
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