Diseases Flashcards
BPH benign prostatic hyperplasia
Lots testosterone converted into DHT via stromal cell 5alpha-reductase causes hyperplasia of prostate glands and stroma in periurethral zone, obstructing the urethra running through
Bladder probs- hypertrophy/trabeculation, urgency, frequency, dysuria, hydronephrosis
Esp men 60+
More glands=more PSA produced
Use 5alpha-reductase inhibitors: Finasteride, Dutasteride
Use alpha-antagonists to relax prostate decr obstruction: Terazosin, Prazosin, Alfuzosin, Doxazosin, Silodosin
Use select alpha-antagonist to avoid affecting bv: Tamsulosin
Prostatic Adenocarcinoma
Adenocarcinoma= “gland malig”
Testosterone exposure induces glandular infiltration of stroma in periphery of posterior prostate.
Not detected until advanced b/c no symptoms/urethral obstruction until get from periphery to center.
1/6 lifetime risk
Usu metastasize to lymph & bone- die from this rather than the cancer at prostate
Diagnose via palpate prostate (cancer= hard)
Definitive Dx w/ biopsy & Gleason sum scoring (8-10 bad prognosis, malignant)
Use testosterone w/drawal cut testes
Use anti-androgen: Flutamide competitive inhib’r of androgen receptor
Use CONTINUOUS GnRH-analog: Leuprolide to decr LH/FSH
Prostate Palpation
Hard= cancer Mushy= prostatitis Springy= BPH
HSV Herpes Simplex Virus
Genital ulcerative STD virus HSV1/2
Lifelong infection that has frequent recurrences tho less severe if reactivated by UV, immunosuppressed
Painful
Vesicular blisters that break into shallow ulcers
Last 2-3 wks
Diagnose via HSV PCR/cell culture
Easiest transmit if acquire near delivery time baby
Use Acyclovir (cheap) Use Valacyclovir (convenient take 1/d) Use Famiciclovir
Haemophilus Ducrey Chancroids
Genital ulcerative STD by bac
*bac painful see voyage story
“School of fish” gram-neg cocco-bacilli
Painful
Has draining bubo fistula
Require special media to grow
Use Azithromycin
Use Ceftriaxone, Ciprofloxacin, Erythromycin
Syphilis
Genital ulcerative STD by Spirochete bac Treponema Pallidum
Primary: Single painless chancre on genital
Secondary: Macular papula rash on palms, sole of feet, scalp & Condyloma Lata contagious warts
Latent: Present in serology but no action
Tertiary: Aortitis, Gummatous syphilis bone/skin lesions, Neurosyphilis tabes dorsalis and decr’d neuro funct
Screen VDRL and RPR titers for progress
Confirm FTA for see if ever had syphilis
Use Benzathine Penicillin IM
Use Doxycycline, Ceftriaxone if allergy
Use Aqueous Crystalline Penicillin IV continuous transfusion if Neurosyphilis EVEN IF allergic (just desensitize)
Chlamydia Trachomatis
Genital discharge STD by bac
Most common STD
Asymptomatic!
Need yearly screen if sex active under 25/hi risk over 25
Cannot culture- hard grow media
Infect rectum, cervix, urethra, cause baby conjunctivitis
Cause PID, ectopic pregnancy, infertility
Diagnose w/ NAAT Nucleic Acid Amplification Test
Use Azithromycin
Use Erythromycin, Doxycycline, Levofloxacin
Neisseria Gonorrhea
Genital discharge STD by bac
Intracell gram-neg diplococci
2nd most common
Discharge both male/female
Also cause rectal infection, pharyngitis
Fitz-Hugh-Curtis Syndrome: R. Upper quadrant pain
DGI disseminated gonococcal infection cause dermatitis, septic arthritis
Infect rectum, cervix, urethra, cause baby conjunctivitis
Cause PID, ectopic pregnancy, infertility
Diagnose w/ NAAT Nucleic Acid Amplification Test
Use Ceftriaxone
Use Cefepime, Ciprofloxacin, Levofloxacin
HPV Human Papilloma Virus
Low risk: HPV 6, 11- genital warts only
High risk: HPV 16,18- cervical cancer b/c have E67 gene which inhibs P53
Very common and clears in 1yr or 2yrs
“Warts” are itchy, burning, bleeding flat papules on genitals
Diagnosis via Pap smear
Pt can use Podofilox/Imiquimod cream
Dr can use cryotherapy liquid N, laser, surgery, trichloroacetic acid
Vaccinate girls starting age 11-12
Gardasil Vaccine: Quadrivalent against all 4 main types 6,11,16,18
Cervarix Vaccine: Bivalent only against cancerous 16,18
Both vaccines are 3 injections at 0, 1 or 2, 6 mo
Lower UTI= Cystitis
Superficial mucosa Bladder infection
Hematuria
Frequency
Dysuria burn
Low grade temp
Don’t need urine culture
Vulvovaginitis
Outer vulva area
Vaginal discharge
Odor
Dysparunia, dysuria
Upper UTI= Pyelonephritis
Involvement all the way up to renal parenchyma
Systemic effects Fever high temps 103-105 Rigors Bacteremia Nausea, vomiting, diarrhea CVA tenderness/flank pain
Need urine culture
Complicated UTI
In the condition that pt is: Male Pregnant Diabetic (have neurogenic bladder) >14d symptoms Foreign GU instrument/stones
Need urine culture
UTI general info
Mostly caused by ascending route and less by hematogenous (except neonate)
E. Coli (UPEC uropathogenic)- GNB
Staph Saprophyticus- gram pos, coagulase neg
Enterococci- if elderly male w/ asymptomatic bacteruria
Other causes:
Catheter-related UTI (most common nosocomial infection)
Diaphragm contraceptive
New partner= decr’d Lactobacilli
Lack of estrogen as age
Mr. PASH pathogensis- pili, aerobacteria, s fimbriae adhesin, hemolysin
Pyuria- 10 WBC/HPF
Bacteruria- 10^5 CFU or 1 bac/HPF
Leukocyte esterase
UTI treatment
Best is Bactrim TMP/SMX trimethoprim sulfamethoxazole for 3d- any longer cause bad effects
2nd best: Ciprofloxacin fluoroquinolones (resistant and expensive)
3rd best: Nitrofurantoin
For complicated UTI, treat with broad spectrum
DO NOT give pregnant ppl TMP, Ciprofloxacin quinolone, or Tetracycline= birth defects
