Genitourinary

Question 0

What can cystitis in men indicate?

Answer 0

It is generally uncommon

It can indicate:

• Underlying bladder or prostate infection
• An obstruction of tumour
• An enlarged prostate

If it is left untreated it can lead to damage of the kidney or prostate

Question 1

What is cystitis?

Answer 1

Inflammation of the bladder (and urethra) caused by infection, irritation or damage

Question 2

What are the symptoms of uncomplicated cystitis?

Answer 2

• Dysuria (painful urination, burning, stinging)
• Urinary frequency & urgency but only passing small amounts of urine
• Nocturia
• Haematuria (dark and strong smelling urine)
• Pain above pubic bone, lower back or abdomen
• Some women may feel systemically unwell

Question 3

What are the referral symptoms for cystitis?

Answer 3

• Children under 12
• Diabetics
• Duration longer than 7 days
• Immuno-compromised patients
• Men
• Patients with associated fever, nausea, vomiting
• Pregnancy
• Abnormal vaginal discharge

Question 4

What can you use to treat cystitis?

Answer 4

• OTC treatment is limited.
• Aim to make urine alkaline, relieving symptoms of dysuria
• Limited evidence of efficacy (Cystopurin, Cymalon, Cystemme, Canesten Oasis)
• Cranberry Juice

Question 5

What advice can you give to a patient with cystitis?

Answer 5

• Paracetamol or ibuprofen can help reduce discomfort and any associated fever
• Drink plenty of water, avoid alcohol
• Avoid intercourse until symptoms resolve
• Avoid perfumed cosmetics and bubble bath etc
• Avoid ignoring call to urinate
• Good hygiene
• Urinate after sex/use of lubricants

Question 6

What are the most common causes of vaginal discharge?

Answer 6

• Vulvovaginal candidiasis (thrush, curd-like discharge, little of no odour)
• Bacterial vaginosis (white discharge, strong fishy odour)
• Trichomoniasis (malodorous, green-yellow in colour)

Question 7

What are the clinical features of thrush?

Answer 7

• Itching
• Sudden onset of symptoms
• Curd-like discharge with little or no smell

Question 8

What are the referral symptoms for thrush?

Answer 8

• First case
• Diabetes
• Discharge with strong smell
• OTC Medicine failure
• Pregnant women
• Recurrent attacks
• Women under 16 and over 60
• STIs

Question 9

What can be used to treat Thrush?

Answer 9

• Topical imidazoles (clotrimazole)

- Systemic antifungal (fluconazole)

Question 10

What time of day should internal preparations for thrush be used?

Answer 10

At night

Question 11

When should Fluconazole not be used?

Answer 11

• Pregnancy or change the patient is pregnant

Question 12

What advice would you give to a patient with thrush?

Answer 12

• Live yogurt can be effective
• Avoid tight clothing, perfumed soap etc
• Symptoms should resolve within 3 days, see GP if no improvement within 7 days
• Treat partner if they are also showing symptoms
• Advise patient on how to insert pessaries

Question 13

What is OTC Tamsulosin used to treat?

Answer 13

Benign Prostatic Hyperplasia (BPH)

Question 14

How long does tamsulosin take to show an improvement?

Answer 14

1 month

Question 15

What are the conditions for supply of tamsulosin?

Answer 15

• Licensed for men aged 45-75

- Must have been suffering for at least 3 months

Question 16

How much tamsulosin is given to the patient?

Answer 16

• Two week initial supply with a further four weeks being supplied if symptoms have improved
• Must see GP by week 6 if further OTC supplies are to be made

Question 17

What is OTC tranexamic acid indicated for?

Answer 17

Menorrhagia (heavy periods)

Question 18

Who is tranexamic acid suitable for?

Answer 18

• Women aged 18-45
• Heavy menstrual loss over several cycles
• Have a regular cycle of 21-35 days