GENITOURINARY MEDICINE

Question 1

Cystitis in who should always be referred?

Answer 1

Men.

Question 2

Symptoms of Cystitis include:

Answer 2

Dysuria (painful urination, burning, stinging)
Increased urinary frequency and urgency but only passing small amounts of urine.
Nocturia.
Haematuria (urine might be dark and strong smelling)
Pain above the pubic bone, lower back or abdomen.
Some women feel systemically unwell.

Question 3

Children younger than what age should be referred if experiencing symptoms of cystitis?

Answer 3

Under 12

Question 4

In which patient groups should a referral be made for symptoms of cystitis?

Answer 4

Diabetics
Elderly women
Immuno-compromised patients of either gender
Pregnancy 
If vaginal discharge is present.

Question 5

Differential diagnosis for cystitis includes:

Answer 5

Thrush
Pylonephritis - sign of systemic infection
Vaginitis
STIs
Medicine induced cystitis: NSAIDS
Oestrogen deficiency - post menopause - frequent cases.

Question 6

How do we manage cystitis in the community pharmacy?

Answer 6

Make urine more alkaline, relieve symptoms of dysuria.

Limited evidence of efficacy of cystopurin, Cymalon, Cystemme, Canesten Oasis.

Question 7

Cystitis symptoms lasting longer than how many days is a sign for referral?

Answer 7

longer than 7 days.

Question 8

What advice should be given to those presenting with cystitis? [7]

Answer 8

1. Paracetamol and ibuprofen can help reduce discomfort and any associated fever.
2. Drink plenty of water and avoid alcohol.
3. Avoid intercourse till symptoms resolve.
4. Avoid perfumed cosmetics/bubble bath etc.
5. Avoid ignoring the call to urinate.
6. Good personal hygiene
7. Urinate following sex/use of lubricants.

Question 9

Cystitis can be medically induced by

Answer 9

NSAID usage

Question 10

Patients with what other symptoms including those associated with cystitis should be referred?

Answer 10

Associated fever, nausea, vomiting and flank pain.

Duration of longer than 7 days.

Question 11

What are the three most common causes of vaginal discharge?

Answer 11

Vulvovaginal candidiasis (thrush-curd-like discharge, little to no odour)

Bacterial vaginosis (white discharge, strong fishy odour)

Trichomoniasis (malodorous, green-yellow in colour)

Question 12

How can thrush be distinguished from vaginosis and trichomoniasis?

Answer 12

Vaginal itching is more prominent in thrush.
Sudden onset of symptoms is less common in vaginosis and trichomoniasis.
No odour in discharge.

Question 13

Those presenting with thrush should be referred when?

Answer 13

1. First case.
2. Diabetes
3. Discharge with strong smell
4. OTC medicine failure
5. Pregnant women
6. Recurrent attacks
7. Women under 16 and over 60.

Question 14

Malodorous, green-yellow in colour describes

Answer 14

Trichomoniasis.

Can lead to infertility.

Question 15

Women of what ages should be referred when presenting with thrush?

Answer 15

under 16

over 60

Question 16

White discharge, strong fishy odour describes

Answer 16

Bacterial vaginosis

Question 17

Should a women experiencing thrush for the first time be referred?

Answer 17

Yes

Question 18

Should a pregnant woman with thrush be referred?

Answer 18

Yes

Question 19

Curd like discharge, little to no odour describes

Answer 19

Vulvovaginal candidiasis

Question 20

What advice should be given to someone receiving topical treatment for thrush?

Answer 20

All internal preparations should be taken at night.

Preparations might affect latex contraceptives.

Question 21

What advice should be given to someone receiving systemic treatment for thrush?

Answer 21

Fluconazole can cause GI disturbances.

Fluconazole should not be used in pregnancy or where there is a chance the patient is pregnant.

Question 22

What practical advice should be given to people receiving treatment for thrush?

Answer 22

Avoid tight clothing, perfumed soaps.
Symptoms should resolve within 3 days, see GP if they do not show improvement in 7 days.
Treat partner if appropriate.

Question 23

What are the conditions for OTC supply of tamsulosin?

Answer 23

Men 45-75
Suffering for at least 3 months.
Must not be supplied if:


Question 24

Who is tranexamic acid for?

Answer 24

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

Question 25

Canestan oasis is used to treat what?

Answer 25

Cystitis

Question 26

What does canestan oasis contain?

Answer 26

Sodium citrate - make urine less acidic/more alkaline.