Genitourinary

Question 1

UTI / cystitis

Answer 1

Common culprit: Proteus species in men and E. Coli in women

COMPLICATED UTI: Men, pregnant, child or s/s pyelonephritis (think systemic symptoms) tx Cipro

Tx uncomplicated UTI: Bactrim DS x5, Macrobid, fosfomycin 3g x1

S/S: dysuria, frequency, urgency, hematuria, suprapubic pain, CV motion tenderness

Question 2

Epididymitis

Answer 2

S/s: UTI like symptoms, scrotal edema, tenderness, +Prehn’s sign indicates Epididymitis (pain relieved c lifting affected testicle), unilateral, hydrocele

If <35yo think STI (C. Trach or N. gonorrhoeae) if >35 wo insertive anal sex think infx d/t obstruction

Tx: 250mg ceftriaxone IM AND
100mg doxycycline PO bid x10d (GC)

Or if enteric organism and STI suspected 
500mg Levofloxacin PO x10d
Or
300mg ofloxacin PO bid x10d
With IM ceftriaxone

Question 3

Testicular torsion

Answer 3

Negative Prehn’s sign

Must be relieved within 6hrs

Cremaster sign is absent
*

Question 4

Pyelonephritis

Answer 4

Most common cause= E. Coli

Tx: cipro

Question 5

Chlamydia

Gonorrhea

Answer 5

1g azithromycin PO X1
Or doxycycline (vibramycin)

250mg Rocephin (ceftriaxone) IM

Question 6

Acute bacterial prostatitis

Answer 6

Commonly presents as a UTI

Predisposing risk factors include bladder outlet obstruction, BPH, immunosuppressive state

Tx: fluoroquinolones, Bactrim or ampicillin c gentamicin x30d

Question 7

Candidiasis (yeast infection)

Answer 7

White clumpy discharge, vaginal pH less than 4.5, hyphae seen under microscope

Tx: 150mg Diflucan PO x1

Question 8

BV

Answer 8

pH over 4.5, clue cells (appear granular, coated c coccobacillary organisms)

Tx: Flagyl 500mg PO bid x7d OR intravaginally x5d

G. Vaginalis