Genitourinary and Gynecological issues and disorders Flashcards
Involuntary urination occurs at an age when voluntary control should be present
Enuresis
Involuntary urination: Children who have never established control
Primary Enuresis
Involuntary urination: Dry for more than six to 12 months and begin wetting
Secondary
Involuntary urination: Incontinence during sleep
Nocturnal enuresis
Involuntary urination: Occurs during waking hours
Diurnal enuresis
Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 3-year-olds
40%
Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 5-year-olds
10%
Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 10-year-olds
3%
Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Approximately ____% of cases are functional
95%
Signs and symptoms of enuresis:
HIstory of _____ wetting
bed
Laboratory/ diagnostics:
- ______
- Urine culture
- Urinalysis
Management:
_______ enuresis
a. Enuresis alarm, positive reinforcement such as
utilizing a star chart
b. Bladder control training (geared toward training the
bladder to hold more urine)
Functional enuresis
Managment:
Functional enuresis
c. Medications:
i. _______ 25 mg daily one hour before bedtime
time one week
ii. Desmopressin (DDAVP): available orally
iii. Oxybutynin (Ditropan): if less than six years for
detrusor muscle hyperactivity associated with
neurological disorders (spina bifida); 5 mg may be
given twice a day to a maximum of 5 mg three
times daily
c. i. Imipramine
Management for enuresis: Treat urinary tract _____ (__) if indicated
Urinary tract infection (UTI)
Bacterial infection and inflammation of the urinary tract are more common in males (uncircumcised) in the first year of life. Increases are seen in females at a 10: 1 ratio throughout the lifespan.
Urinary tract infection
Both the male and female UTI in childhood are typically caused by the following organism
a. ___ ___ 80 to 90%
b. _____ _____
a. E. Coli
b. Staphylococcus aureus
Predisposing factors include urinary _____, congenital or acquired obstructive lesions, non-obstructive causes ( e.g. neurologic bladder, poor hygiene, constipation, and sexual intercourse)
stasis
High-grade ______ reflux (VUR) may result in renal scarring, eventual hypertension, and renal failure related to urinary tract infection
vesicoureteral
Signs and symptoms of UTI in Infant include:
a. May have ____ signs or symptoms
b. Weight loss, FTT
c. dehydration
d. irritability
no
Signs and symptoms of UTI in children and adolescents include:
a. dysuria
b. _______
c. urgency
d. nocturia
e. suprapubic/ lower abdominal discomfort
f. hematuria
g. fever
b. frequency
Laboratory/ diagnostics for UTI:
a. A straight catheter (cath) or bladder tap for
culture/sensitivity is indicated in those who cannot void
voluntarily [ clean catch may be used for mild symptoms
or follow up]
b. UA: Leukocytse, ______, nitrites
c. ______ in the complete blood count (CBC)
b. erythrocytes
c. Leukocytosis
Management of UTI:
- Oral antibiotics for 10 to 14 days
a. [trimethoprim/sulfamethoxazole
b. Cephalosporins
c. Amoxicillin
d. Sulfisoxazole
e. ___________
- e. Nitrofurantoin
UTI:
Follow up in ___ days; change antibiotics if no improvement is seen.
Follow up in one to two weeks, then every one to three months for one year
two
Note: Children < ____ months of age with UTI should be hospitalized for parental antibiotics
2 months
Management for UTI:
a. Febrile infants
b. children 2 to 24 months
______ is indicated if ultrasound abnormal
Antimicrobial prophylaxis is not indicated
VCUG
A relatively common congenital abnormality in which the urethral opening is on the ventral surface (underside) of the penis
Hypospadias
a. The etiology is unclear; currently hypothesized to be a
deformity rather than a malformation
b. Occurs in 8.2: 1,000 live births or 1: 300 male infants;
often familial
c. Likelihood of other genitourinary (GU) anomalies such as
undescended testicles, inguinal hernia. or hydrocele is
noted
Hypospadias
Signs and symptoms of hypospadias
- Dorsally hooded foreskin (classic finding)
- urinary stream that aims downward
- _______ (ventral bowing of the penis)
- Chordee
Laboratory/ Diagnostics: hypospadias
- ___ lab test
- Diagnosis is made by clinical findings
No
Management: hypospadias
- Referral to a urologist at birth
- circumcision must ____ ___done (Foreskin is used in repair)
- Surgery is best done around 6 to 12 months of age
- not be
Absence of one or both of the testes from the scrotal sac due to failure to decent from the abdomen in utero
1. Occurs in 3% of newborn males and 20 to 30% of the
premature male newborn (descent normally occurs
during the last trimester)
Cryptorchidism (Undescended Testes)
Signs and symptoms of cryptorchidism
- Inability to palate ______
- Often no symptoms
- testicle
Laboratory/ diagnostics: cryptorchidism
- None typically
- If bilateral, karyotyping for _______ abnormalities may be ordered
- chromosomal
Management: cryptorchidism
- If undescended at ___ years refer to urology
- Testicular self- examination (TSE) for increased testicular cancer probability
- 1 year
Twisting and strangulation of the spermatic cord characterized by acute pain; constitutes a surgical emergency to prevent necrotic testicle and infertility
Testicular torsion
Cause/Incidence of Testicular Torsion:
1) Occurs most often in ____ to __ age group
2) Does not represent an infectious process
3) Interruption of the vascular flow produces acute pain
10 to 20 age group
Signs and symptoms of Testicular torsion:
1) Acute onset creates profound pin
2) Lack of irritative voiding symptoms
3) No systems symptoms and no fever
4) The affected testis may have a “ high lie”
5) Pain is not relieved by elevating scrotum
6) Absent __________ reflex
6) cremasteric
Stroking inner thigh results in retraction of the testicle on the same side
Creamateric reflex
Laboratory/ diagnostics: Testicular torsion
1) ______ in primary care
1) None
Management of Testicular torsion:
1) Refer for emency _______ intervention
surgical
Pain and cramping associated with menstruation?
Dysmenorrhea
________ dysmenorrhea
a) Absence of any pelvic pathology; is most commonly seen in adolescents
b) The etiology of _______ dysmenorrhea is believed to be hormonal and endocrine-related
c) Most causes of _____ dysmenorrhea begin 6 to 12 months after menarche, who symptoms gradually increasing until patients are in their mid-20s.
Primary
________ dysmenorrhea results from an underlying cause wich as pregnancy, pelvic inflammatory disease (PID), and endometriosis
Secondary
Signs and symptoms of dysmenorrhea include:
1) Painful menses
2) Lower abdominal pain associated with menstruation, usually worse in the first few days of bleeding
3) Associated pain
4) May be nausea, vomiting, fatigue, headache, and diarrhea
3) back
Laboratory/ diagnostics for dysmenorrhea include:
a) ______ dysmenorrhea: No testing necessary; diagnosis is made clinically
b) Testing for ____ dysmenorrhea: according to the suspected underlying cause
a) Primary
b) Secondary
Management of dysmenorrhea include:
1) Education about menstruation proper diet
2) Support measure:
a) Heat application
b) Psychological support
c) Over the counter (OTC) analgesics, preferably
________: 400 mg every four to six hours, beginning
at the onset of the menstrual cycle and continuing for
2 to 72 hours
3) Stronger non-steroidal anti-inflammatory drugs (NSAIDs) for moderate to severe dysmenorrhea
4) Oral contraceptives
5) Referral as needed
2) c) ibuprofen
A parasitic sexually transmitted disease, intracellular obligate which closely resembles a gram-negative bacteria; produces serious reproductive tract complications in with sex
Chlamydia
Causes/ Inceidnece of this STD. It occurs from Chlamydia trachomatous
Chlamydia
Most common bacterial STD in the United States.
Chlamydia
Over four million infections annually from this STD?
Chlamydia
Remains the most common cause of cervicitis and urethritis in adolescents
Chlamydia
Signs and symptoms of Chlamydia include:
1) Female often _______
a) Dysuria
b) intermenstrual spotting
c) postcoital bleeding
d) dyspareunia
e) vaginal discharge
f) lower abdominal and pelvic pain
g) rectal tenesmus
1) asymptomatic
Signs and symptoms of Chlamydia include:
2) Male often asymptomatic
a) Dysuria
b) thick, cloudy, penile discharge
c) testicular pain
d) rectal __________
2) d) tenesmus
Laboratory/ diagnostics of Chlamydia include:
a) Culture is most definitive but takes three to nine days
b) ______ _____ (__) for screening: Results in 30 to 120 minutes; low cost
b) Enzyme immunoassay (EIA)
Management of Chlamydia include:
1) _______ (_____) one gram orally in single dose or:
2) _______ (______) 100 mg orally twice a day for seven days
3) _____, ______, or _______ if pregnant
1) Azithromycin (Zithromax)
2) Doxycycline (Vibramycin)
3) Azithromycin, erythromycin, or amoxicillin
A bacterial STD caused by Neisseria gonorrhoeae (gram-negative diplococci); the organism may be cultured from the genitourinary tract, oropharynx, conjunctiva and or anorectal
Gonorrhea
Cause/ Incidence of Gonorrhea include:
1) Causes urethritis in men and cervicitis in women
2) Leading cause of ______ among females
2) infertility
Signs and symptoms of Gonorrhea include:
1) Females are often asymptomatic (____%)
a) Dysuria
b) Urinary frequency
c) Mucopurulent vaginal discharge
d) Labial pain/ swelling
e) Lower abdominal pain
f) fever
g) ____________
h) nausea/ vomiting
1) 80%
g) dysmenorrhea
Signs and symptoms of Gonorrhea include:
2) Male is often asymptomatic
a) Dysuria
b) Frequency
c) _____/__________ penile discharege
d) Testicular pain
c) White/ yellow-green
Laboratory/ diagnostics for Gonorrhea:
1) Gram stain of discharge shows gram-_____ ______ and white blood cells (WBCs)
2) Clerical culture for N.gonorrhoeae using Thayer-Marting or Transgrow media
1) negative diplococci
Management of Gonorrhea infection include:
1) _____________ intramuscular single dose
2) _______ ( ___) 1 gram orally x 1 dose to cover for chlamydia
3) ________ 100 mg orally x2 daily for seven days
4) Co- treat for chlamydia
5) All contact should be treated
6) Report to the health department
1) Ceftriaxone (Rocephin)
2) Azithromycin ( Zithromax)
3) Doxycycline
A sexually transmitted disease involving multiple organ systems and caused by Treponema pallidum a spirochete; the causative organism may be transmitted across the placenta
Syphilis
_______: Typical lesion or nearly positive syphilis screen
a) dark-field micsopy show treponemes in 95% of chances
Primary
________: clinical presentaiton with strongly reactive syphilis screen
Secondary
Latent _______: serologic evidence of untreated syphilis
Tertiary
_________
a. Chancre presents at the site of inoculation two-six weeks after exposure
b. Chancre indurated and painless
c. Regional lymphadenopathy
Primary
_______ syphilis
a) Seropositive, but asymptomatic
b) About 1/3 of untreated cases develop ____syphilis
Latent
b) tertiary
_________
a) Occurs six to eight weeks later
b) Flu-like symptoms
c) Generalized lymphadenopathy
d) Generalized maculopapular rash, especially on the palms and soles
Secondary
_________
a) Leukoplakia
b) Cardiac insufficiency: aortic, aneurysms, aortic regurgitation
c) Infiltrative tumors of skin, bones, liver
d) Central nervous system (CNS) involvement: meningitis, hemiparesis, hemiplegia, others
Tertiary
Serologic test: syphilis
1) Screening with non-________ antibody test: Veneral disease research laboratory (VDRL) and/ or rapid plasma reagin (RPR)
2) Confirmed with treponemal tests
a) Fluorescent treponemal Antibody Absorption (FTA-
ABS): Following the non- treponemal screen.
b) Microhemagglutination Assay for Antibody to
Reeponema Pallidim (MHA-TP)
1) treponemal
Management of Syphilis is:
a) ____________________
a) Benzathine Penicillin G
Management of Syphilis with PCN allergy is?
a) ___________
b) ___________
a) Doxycycline
b) Erythromycin
Syphilis _______ all cases to the health department
report
A vaginal infection in which several species of bacteria interact to alter the vaginal flora
Bacterial Vaginosis
Cause/ Incidence: bacterial Vaginosis
1) Increased pH and decreased __________
2) Most prevalent vaginal infection in women of reproductive age
3) ______ considered an STD/STI; seen more often in sexually active women
1) lactobacilli
3) Not
Signs and symptoms of bacterial vaginosis
a) increased ____ discharge
b) may have pruritus
c) Malodours “_____” discharge most evident after sexual intercourse
d) Cervicx/uterus/ adnexa within normal limits
a) milky
c) fishy
Laboratory/ Diagnostics for bacterial vaginosis
1) Wet mount
a) ____ cells: Epithelial cells covered with bacteria appear stippled (small dots or specks) with poorly defined borders
b) decreased/ absent lactobacilli
c) Few or absent WBC
2) Positive amine “whiff” test (fishy odor when potassium hydroxide (KOH) added to slide)
1) a) Clue cells
Laboratory/ Diagnostics for bacterial vaginosis
2) Positive amine “____” test (fishy odor when potassium hydroxide (KOH) added to slide)
2) “whiff”
Treatment for bacterial vaginosis:
1) ________ PO
2) ________ PO
3) Intravaginal ______ or _______
1) Metronidazole
2) Clindamycin
3) metronidazole or clindamycin
A recurrent, viral sexually transmitted disease that is associated with painful lesions
Herpes
Herpes-type ____: Found on the lips, face, and mucosa
Type 1
Herpes-type ____: Found on the genitalia
Type 2
Transmission by _____ contact with active lesions or by circus containing fluid (e.g. saliva or cervical secretions)
direct
Signs or symptoms for ______
1) Initial Fever, malaise, dysuria, painful/ pruritic ulcer for 12 days
2) Recurrent: Less painful/ pruritic ulcers for 5 days
Herpes
Laboratory/ diagnostics for herpes include?
- _____ or Tzanck stain
- ____ _____ is most diefinitivae
- Papanicolaou
2. Viral culture
Managment of herpes include?
1. _____ _____ treatment
2. Symtomatic treatment with drying and antipruiritic agents
3. Treatment options
a. ______ topical, oral, IV
b. ________ especially useful for asymptomatic viral
shedding of HSV-2
- No curative treatement
- a. Acyclovir ( Zovirax)
b. Valacyclovir
A disorder characterized by immunodeficiency as the result of infections by the human immune deficiency virus
Acquired Immune deficiency syndrome (AIDS)
Mode of transmission typically with AIDS is how?
Maternal infant perinatal transmission
______ is primary postanatl vertical route
Breastfeeding
Signs and symptoms of ______ include
a) Low birth weight and the falling ratio of head circumference to height/weight
b) Recurrent infections
c) diminished activity
d) developmental delay
e) hepatosplenomegaly, generalized lymphadenopathy
Acquired Immune deficiency syndrome (AIDS)
Screening in infants
1) ____ birth weight and a falling ration of head circumference to height /weight
2) recurrent infections
3) diminished activity
4) developmental delay
5) hepatosplenomegaly, generalized lymphadenopathy
1) Low
Laboratory/ diagnostics Screening in infants for HIV includes?
HIV polymerase chain reaction (PCR)
In older children, the ____-____ _____ ____ (___) screening is used (sensitivity >99.9%)
enzyme-linked immunosorbent assay (ELISA)
Confirmatory test for laboratory AIDS?
The western blot test is confirmatory
Progress towards AIDS
a) absolute CD4 lymphocyte count: Normal > ____ cells/uL
b) CD4 lymphocyte percentage of WBC
1) Risk of progression to AIDs high when < ___%
c) Viral load ideally, should be < 5000 copies, or “ zero” or “undetectable”
a) >800 cells/uL
b) 1) < 20%
Management of opportunistic infections with AIDS
a) ____ for pneumocystis pneumonia (Pneumocystis jiroveci) preventions
b) Monitor for ____
a) Bactrim
b) CMV
Management of AIDS with antiretroviral treatment
a) combination treatment : With ______ _____ (___)
b) Start no later than when the patient has a CD4 of 350uL
c) Drug resistance may develop readily; teach to take the medication exactly as prescribed: at the same time every day
d) Referral to an HIV infectious disease specialist
a) antiretroviral therapy (ART)
Management of Menopause?
a) Hormonal therapy
ii) Estrogen: Conjugated estrogen (_____), estradiol
(Estrace, Estraderm, Climara), Estrone sulfate
Premarin
Management of Menopause:
b) ______: cyclic or continuous (not necessary if hysterectomy)
Progestin
Management of Menopause:
c) ______, calcium supplementation (recommended in the present and absence of estrogen), and diet if HT is contraindicated or refused
c) Exercise
Management of Menopause:
d) Benefits/ risk must be made based on the three major possible concerns in family history:
i) _____ cancer
ii) Myocardial infarction/ CAD
iii) Uterine cancer
i) Breast cancer
Change of bone structure due to graduation in quantity, rather than composition, resulting in an abnormally low bone mass leading to increased risk of fractures
Osteoporosis
____ sexes experience a bone loss with again (type 2 osteoporosis)
Both
Osteoporosis in menopause results from the loss of stronger (type ___ osteoporosis)
1
___ of bone loss is due to hypoestrogenic states rather than to the aging process itself
3/4
