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PNCB2 > Genitourinary and Gynecological Issues and Disorders > Flashcards

Genitourinary and Gynecological Issues and Disorders Flashcards

1
Q

Enuresis defintion and types

A

involuntary urination occurs at any age when voluntary control should be present
Types:
primary: children who have never established control
secondary: dry for more than 6-12 months and begin wetting
nocturnal: incontinence during sleep
diurinal: occurs during waking hours

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2
Q

Incidence of enuresis

A

40% in 3 yr olds
10% in 5 yr olds
3% in 10 yr olds
95% of all case are functional

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3
Q

Management of enuresis

A

enuresis alarm, positive reinforcement chart
bladder control training–teach bladder to hold more
hypnosis/self hypnosis

medications:
imipramine–one hour before bedtime x1 week
DDAVP
oxubutynin–if less than 6 years old for detrusor muscle hyperactivity associated with neurological disorders

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4
Q

UTI causative organisms

A

e coli 80-90%

staphylococcus aureus

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5
Q

S/sx of UTI in infants

A

may be asymptomatic
weight loss, FTT
dehydration
irritability

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6
Q

S/sx of UTI in children/adolescents

A 
dysuria
frequency 
urgency 
nocturia
suprapubic, lower abdominal discomfort
hematuria 
fever
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7
Q

Management of UTI

A

oral antibiotics for 10-14 days:
trimethoprim/sulfmethoxazole
cephalosporins
amoxicillin

  • *follow up in 2 days and change antibiotic if not improvement
  • *Follow up in 1-2 week, then every 1-3 months for a year for a UA

Children less than 2 months of age with a UTI should be hospitalized for IV antibiotics

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8
Q

When to do a renal US and/or VCUG?

A

Renal US after first UTI in children 2-24 months and/or febrile infants
VCUG is indicated if US is abnormal

**antimicrobial prophylaxis is not indicated

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9
Q

Hypospadias

A

common congenital abnormality in which urethral opening is on the ventral surface of the penis

**if baby has this, may have other GU abnormalities (undescended testes, inguinal hernia, hydrocele)

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10
Q

S/sx of hypospadias

A

dorsally hooded foreskin **classic finding
urinary stream that aims downward
chordee (ventral bowing of the penis)

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11
Q

Management of hypospadias

A

referrals to urologist at birth
circ must not be done bc foreskin is used in repair
surgery best around 6-12 months

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12
Q

Cryptorchidism

A

undescended testes
very common in premature infants as descent typically happens in 3rd trimester

If doesn’t happen by 1 year–refer to urology
teach testicular self exam bc higher risk of testicular cancer

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13
Q

Testicular torsion

A

twisting and strangulation of the spermatic cord characterized by acute pain; constitutes a surgical emergency to prevent necrotic testicle and infertility

  • most often happens in the 10-20 age group
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14
Q

Signs and symptoms of testicular torsion

A

acute onset of pain
affected testes may lie high
pain not relieved by elevating scrotum

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15
Q

Phren’s sign

A

pain not relieved by elevating scrotum with testicular torsion

Phren–Penis

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16
Q

Dysmenorrhea

A

pain and cramping with menstruation

Primary:absence of any pelvic abnormality, typically begin 6-12 months after menarche, with symptoms increasing until mid 20s

Secondary: underlying cause–pregnancy, PID, endometriosis

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17
Q

Why does ibuprofen work for dysmenorrhea and how should you prescribe someone to take it?

A

400 mg every 4-6 hours beginning at the onset of the menstrual cycle and continuing for 24-72 hours

Take 2 days before and after

ibuprofen decreases prostaglandin release, which causes muscle cramps

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18
Q

Chlamydia

A

parasitic STD
most common cause of cervicitis and urethritis in adolescents
most common in those 18-24 years old

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19
Q

Female s/sx of chlamydia

A 
often asymptomatic
dysuria
intermenstrual spotting
postcoital bleeding (after intercourse)
dyspareunia (painful intercourse)
vaginal discharge
lower abdominal/pelvic pain
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20
Q

Males s/sx of chlamydia

A

often asymptomatic
dysuria
thick, cloudy penile discharge
testicular pain

21
Q

What test is used to check for chlamydia?

A

enzyme immunoassay for screening–results in 30-120 min, cheap

culture is most definitive but takes 3-9 days

22
Q

Management of chlamydia

A

azithromycin– 1 gram in single oral dose
doxycycline 100 mg orally twice a day x 7 days
report to health department

23
Q

Gonorrhea

A

bacterial STD–can be cultured from GU tract, oropharynx, conjunctiva, and anorectum

leading cause of infertility in females

24
Q

S/sx of gonorrhea in females

A 
80% asymptomatic
dysuria
urinary frequency
mucopurulent discharge 
labial pain/swelling
lower abdominal pain
fever
dysmenorrhea
nasuea and vomiting
25
Q

S/sx of gonorrhea in males

A

dysuria
frequency
white/yellow, green penile discharge
testicular pain

26
Q

Lab tests for gonorrhea

A

gram stain of discharge shows gram-negative diplococci and WBCs
cervical culture using thayer-martin or transgrow media

27
Q

Management of gonorrhea

A

ceftriaxone IM one dose
azithromycin 1 gram orally x 1 dose (covers chlamydia)
doxycycline 100 mg orally x 2 daily x 7 days
co-treat for chlamydia
report to health dept

28
Q

Syphilis

A

STD caused by treponema palladium, a spirochete–which can be transmitted across the placenta

29
Q

What is the primary diagnosis of syphilis, secondary and latent diagnosis of syphilis?

A

primary: typical lesion or newly positive syphilis screen–dark filed microscopy shows treponemes in 95% of chancres
secondary: clinical presentation with strongly reactive syphilis screen

latent/tertiary: serologic evidence of untreated syphilis

30
Q

Primary stages of syphilis

A

chancre present at site of inoculation 2-6 weeks after exposure
chancre indurated and painless
regional lymphadenopathy

31
Q

Secondary stages of syphilis

A

occurs 6-8 weeks later
flu-like symptoms
generalized lymphadenopathy
generalized maculopapular rash, especially on palms/soles

32
Q

Latent and tertiary stages of syphilis

A

latent: seropositive, but asymptomatic , about 1/3 untreated cases develop tertiary
tertiary: leukoplakia, cardiac insufficiency, infiltrative tumors of skin, bones, liver, and CNS involvement

33
Q

Serologic tests of syphilis

A

general disease research lab (VDRL) and/or rapid plasma reagin
Confirmed with treponema tests

34
Q

Management of syphilis

A

penicillin G
or doxycycline or erythromycin in those allergic to penicillin

report all cases to health department

35
Q

Bacterial Vaginosis

A

a vaginal infection to which several species of bacteria interact to alter the vaginal flora
most prevalent vaginal infection in women of reproductive age
not considered an STD/STI, but seen more often in sexually active women

36
Q

Symptoms of bacterial vaginosis

A

increased milky discharge
may have pruritus
malodorous “fishy” discharge most evident after sexual intercourse

37
Q

Wet mouth of bacterial vaginosis

A

clue cells–epithelial cells covered with bacteria
decreased/absent lactobacilli
few or absent WBC
post amine whiff test–fishy odor with KOH added to slide

38
Q

Treatment of bacterial vaginosis

A

metronidazole PO
clindamycin PO
**or intravaginal of either

39
Q

Herpes

A

recurrent, viral STD associated with painful lesions that you have for rest of life caused by HSV

type 1: lips, face, mucosa
type 2: genitalia

Transmission by direct contact with active lesion or by virus containing fluid

40
Q

Signs and symptoms of herpes

A

initial: fever, malaise, dysuria, painful/pruritic ulcers for 12 days
recurrent: less painful/pruritic ulcers for 5 days

41
Q

lab diagnosis of herpes

A

papanicolaou or tzanck stain

viral culture is most definitive

42
Q

Management of herpes

A

no curative treatment
symptomatic treatment with drying and antipruritic agents
treatment options:
acyclovir: topical, oral, IV
valacyclovir: especially useful for asymptotic viral shredding of HSV-2

43
Q

AIDS epidemiology

A

characterized as the result of infections by HIV

modes of transmission typically maternal infant perinatal transmission
breastfeeding is primary positional vertical route (contraindicated)

44
Q

Signs and symptoms of AIDS

A

low birth weight and falling ratio of head circumference to height/weight
recurrent infections
diminishing activity
developmental delay
hepatosplenomegaly, generalized lympahdenopathy

45
Q

Screening and confirmatory testing for AIDS

A

in infants: HIV PCR testing
in older children: ELISA screening is used

western blot test is confirmatory

46
Q

Progress towards AIDS

A

absolute CD4 lymphocyte count: normal >800

CD4 lymphocyte percentage of WBC–risk for progression of AIDS is high when

47
Q

Prevention of opportunistic infections in those with HIV

A

trying to prevent from HIV turning into AIDS

bactrim for pneumocystitis pneumonia prevention
monitor for CMV

48
Q

Antiretroviral treatment in those with HIV

A

combination treatment–with antiretroviral therapy
start no later than when the patient has a CD4 of 350
drug resistance develops readily–take meds exactly as prescribed at same time each day

PNCB2 (18 decks)

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