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FEP MDT S/Sx's > Geniturinary > Flashcards

Geniturinary Flashcards

1
Q
  • More of a symptom than an actual diagnosis
  • Describe timing of gross hematuria (initial, terminal or total)
A

Hematuria

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2
Q
  • Irritative voiding symptoms; frequency, urgency, dysuria
  • Suprapubic discomfort or TTP
  • Women may experience hematuria and symptoms often appear following sexual intercourse
A

Acute Cystitis

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3
Q

•Fever, flank pain, irritative voiding symptoms, shaking chills, associated N/V/D, tachycardia and costovertebral angle tenderness is usually pronounced
**MEDEVAC**

A

Pylenophritis

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4
Q

•Perineal, sacral or suprapubic pain with high fever
•Irritative voiding symptoms
•Obstructive symptoms leading to urinary retention
•Warm and often exquisitely tender prostate is detected on examination
**MEDEVAC**

A

Acute Prostatitis

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5
Q

•Variable degree or irritative voiding symptoms
•Low back pain and perineal pain
•Suprapubic discomfort
•History of UTI’s
•Prostate may be normal, boggy, or indurated
•Diagnosed with a good history
**MEDEVAC**

A

Chronic Bacterial Prostatitis

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6
Q
  • May follow acute physical strain; heavy lifting, trauma, or sexual activity
  • Associated symptoms of urethritis and cystitis
  • Pain develops in the scrotum and may radiate along the spermatic cord or to the flank
  • Fever, scrotal swelling, and the epididymis may be distinguishable from the testes (testes may appear as one enlarged mass)
  • Prostate may be tender on rectal examination
  • Prehn Sign (elevation of the scrotum above the pubic symphysis improves pain from epididymitis)
A

Epididymitis

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7
Q

•Sudden onset of pain that is typically localized to the flank
•May be associated with nausea and vomiting
•Patients are constantly moving trying to find a comfortable position
•Pain may occur episodically and may radiate anteriorly over the abdomen and as stone progresses down the ureter pain may be referred to the ipsilateral groin
•Obstructing stones usually present with acute, unremitting, and severe colic
**“If obstructing stone with associated infection - MEDEVAC!**

A

Urinary Stone

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8
Q

•The consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance
•PT history is critical to the proper classification and treatment
•Androgen deficiency, arterial, venous, neurogenic, hormonal, or psychogenic causes, concurrent medical problems
•Most common cause is a decrease in arterial flow resultant from progressive vascular disease
•Medications such as antihypertensives, antidepressants, and opioid agents
***IF Priapism MEDEVAC**

A

Erectile DYsfunction

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9
Q
  • Symptoms can be obstructive component of the prostate of to the secondary response of the bladder to the outlet resistance (irritative)
  • Obstructive - hesitancy, decreased force and caliber of stream, sensation of incomplete bladder emptying, double voiding, straining to urinate, post-void dribbling
  • Irritative - urgency, frequency, nocturia
  • American Urological Association (AUA) symptom index is the most important tool used in the evaluation of patients with BPH (scale of 0-5)
  • DRE will show smooth, firm, elastic enlargement of the prostate (induration should alert you of the possibility of cancer)
A

Benign Prostatic Hypertrophy (BPH)

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10
Q
  • MOST prostate cancers are detected because of elevations in serum PSA (not DRE)
  • May manifest as focal nodules or areas of induration within the prostate upon DRE examination
  • Rarely present with signs of urinary retention or neurological symptoms secondary to epidural metastases
  • Axial skeleton is most common site of metastases (PT may present with back pain)
A

Prostate Cancer

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11
Q

•TTP, ecchymosis, swelling, laceration, bleeding
**MEDEVAC**

A

Scrotal Trauma

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12
Q

•Starts as a benign infection or simple abscess that quickly leads to widespread necrosis of otherwise previously healthy tissue
•Scrotal, rectal, or genitalia pain out of proportion to their physical exam findings
•Tense edema of scrotum and other involved skin, blisters/bullae, crepitus, fever, pain, tachycardia and hypotension
**MEDEVAC**

A

Fournier’s Gangrene

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13
Q
  • Feels like a “bag of worms”, especially in upright position
  • Usually asymptomatic, some patients have mild pain
  • Mass is separate from testes
  • Size increases with Valsalva maneuver
A

Varicocele

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14
Q
  • Gradually enlarging painless cystic mass that transilluminates
  • May indicate tumor
A

Hydrocele

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15
Q
  • Fuild filled cyst at the head of the epididymis that may contain nonviable sperm
  • Painless, palpated a distinct from the testes, typically transilluminates as cystic in nature
A

Spermatocele

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16
Q

Painless enlargement of the testes; patient is usually first to recognize but delay in seeking medical attention for 3-6 months
•Sensation of heaviness
•Acute testicular pain because of intra-testicular hemorrhage occurs in about 10% of patients
•10% are asymptomatic in presentation
•10% manifest with symptoms of metastatic disease - back pain, cough, lower extremity edema
•5% of PTs present with Gynecomastia

A

Testicular Mass

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17
Q

•Acute scrotal pain often occurring several hours after vigorous physical activity or minor trauma to the testicles
•Profound tenderness and swelling, nausea and vomiting
•Negative cremasteric reflex due to impingement of cremasteric muscle and nerve
•Bell Clapper deformity - high riding tetes oriented transversely
**MEDEVAC**

A

Testicular Torsion

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18
Q
  • Rupture of the corpus cavernosum
  • Immediate pain, deforming hematoma (eggplant deformity), ““cracking sound””, immediate loss of erection (detumescence), may cause urethral injury

•Self inflicted injuries, amputation, vacuum injuries, zipper injuries, constricting/strangulation injuries, degloving injuries, penetrating injuries (animal bites, GSW, stabbing injuries), contusions
**MEDEVAC**

A

Penile Rupture/Fracture

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19
Q
  • Fibrous constriction of the foreskin preventing retraction that can be the result of Balanitis or Balanoposthitis
  • May cause urinary retention
A

Phimosis

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20
Q

•Retracted foreskin develops a fixed constriction proximal to the glans
•Penis distal to the constricting foreskin may become swollen and painful, or even gangrenous, and urinary retention may result
**MEDEVAC**

A

Paraphimosis

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21
Q

•Sudden decrease in kidney function and is characterized as an increase in serum creatinine
•Oliguria may be present (<400-500ml of urine/day)
•Three categories - Pre-renal (kidney hypoperfusion leading to decreased GFR), Intrinsic kidney disease, and Post-renal (obstructive uropathy)
•UREMIA - nausea, vomiting, altered sensorium, pericarditis, malaise
•Pericardial effusion leading to tamponade and friction rub, arrythmias, rales in hypervolemia, nonspecific abdominal pain and ileus
•May experience symptoms and signs of the underlying disease process causing their AKI, may be hyper/hypovolemic
**MEDEVAC**

A

Renal Failure (Acute Kidney Injury AKI)

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22
Q
  • Serum sodium concentration less than 135 mEq/L (135 mmol/L) often caused by hypotonic fluids
  • Usually reflected by excess water retention relative to sodium rather than sodium deficiency

MILD - nausea, malaise

MODERATE - headache, lethargy, disorientation

SEVERE - respiratory arrest, seizure, coma, permanent brain damage, brainstem herniation, death
**MEDEVAC if showing severe signs**

A

Hyponatremia

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23
Q
  • Sodium concentration greater than 145 mEq/L
  • Typically hypovolemic due to free water losses
  • Dehydration patients, orthostatic hypotension, oliguria

EARLY SIGNS
•Lethargy, irritability and weakness

SEVERE SIGNS (usually Sodium \>158mEq/L) 
•Hyperthermia, delirium, seizures, coma 
\*\*MEDEVAC if showing severe signs\*\*
A

Hypernatremia

24
Q
  • Serum potassium levels less than 3.5 mEq/L (3.5 mmol/L)
  • Most common cause is GI loss from infectious diarrhea

MILD - MODERATE
•Muscular weakness, fatigue, muscle cramps

SEVERE (less than 2.5 mEq/L)
•Flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomyolysis
**MEDEVAC if showing severe signs**

A

Hypokalemia

25
Q

•Serum potassium levels greater than 5.0 mEq/L (5.0 mmol/L)
•May develop in patients taking ACEi, angiotensin receptor blockers, potassium-sparing diuretics
•Impairement of neuromuscular transmission - muscle weakness, flaccid paralysis, ileus
**MEDEVAC if showing severe signs**

A

Hyperkalemia

26
Q
  • Breast pain or tenderness, discomfort worsens during premenstrual phase of cycle
  • Fluctuation in size of masses, multiple or bilateral
  • Most common age is 30-50
A

Fibrocystic Condition

27
Q
  • Round or ovoid, rubbery, dicrete, relatively movable, nontender mas 1-5cm in diameter
  • Occurs most frequently in young women (black women)
A

Fibroadenoma

28
Q
  • Produces a mass often accompanied by skin or nipple retraction and ecchymosis
  • Commonly seen after fat injections to augment breast size or to fill defect after breast surgery
  • Trauma is presumed to be the cause
A

Fat Necrosis

29
Q
  • Patients usually present with a painless lump
  • Breast pain, nipple discharge, erosion, retraction, enlargement, or itching of the nipple
  • Redness, generalized hardness, enlargement, or shrinking of the breast
  • Age (60s-70s) is the most significant factor
  • Exam will show single, nontender, hard mass with ill defined margins
  • Late Signs - Skin or nipple retraction, axillary lymphadenopathy, breast enlargement, erythema, edema, pain, fixation of mass to skin or chest wall
A

Female Breast Carcinoma

30
Q
  • PT usually presents with a painless lump with or without nipple discharge, retraction, ulceration, or erosion
  • Hard, ill defined, nontender mass beneath the nipple or areola
  • Current or history of Gynecomastia
A

Male Breast Carcinoma

31
Q
  • Nipple Discharge
  • Serous - duct ecstasia, Bloody - neoplasticpapilloma or carcinoma, Associated mass - most likely neoplastic, Unilateral - neoplastic or non-neoplastic, Bilateral - non neoplastic
A

Nipple Discharge

32
Q
  • May have painful menstrual cramping
  • May be asymptomatic except for spotting
  • Could have signs of anemia (fatigue, pallor, lightheadedness or dizziness with exertion, pica, weakness, or headache)
  • Dx depends on the following; Hx of the duration and amount, associated pain, relationship to LMP, Hx of pertinent illnesses (recent systemic infections, physical or emotional stressors such a thyroid disease or weight change), Hx of medications (warfarin, heparin, exogenous hormones), Hx of coagulation disorders
A

Abnormal Uterine Bleeding

33
Q

•Bloating, breast pain, ankle swelling, a sense of increased weight, skin disorders, irritability, aggressiveness, depression, inability to concentrate, libido change, lethargy, food cravings

PMS
•Physical and emotional symptoms that develop during the 5 days before the onset of menses and subsides within 4 days after menstruation occurs

PMDD
•Mood or emotional symptoms predominate along with the physical symptoms and there is a clear functional impairment with work or personal relationships

A

Premenstrual Dysphoric Disorder

34
Q
  • Vaginal irritation or pruritus, pain, unusual or malodorous discharge
  • Bimanual exam might show pelvic inflammation, cervical motion tenderness, adnexal tenderness
A

Vaginitis

35
Q

•Pruritus, vulvovaginal erythema, white curd like discharge that is NOT malodorous

A

Vulvovaginal Vaginitis

36
Q
  • Malodorous, frothy, yellow-green discharge along with diffuse vaginal erythema
  • Strawberry cervix - red macular lesions (severe)
A

Trichomonas Vaginitis

37
Q

•Increased malodorous discharge without obvious vulvitis or vaginitis

A

Bacterial Vaginosis

38
Q
  • Periodic painful swelling on either side of the introitus
  • Dyspareunia
  • Fluctuant swelling 1-4 cm in diameter lateral to either labium minus - sign of occlusion of Bartholin duct
  • Tenderness is evidence of active infection
A

Bartholin Gland Abscess

39
Q
  • No symptoms or signs for cervical dysplasia
  • Presumptive diagnosis is made by an abnormal Papanicolaou (PAP) smear of an asymptomatic woman with no grossly visible cervical changes
A

Cervical Dysplasia

40
Q

•Discrete, round, firm, often multiple uterine tumor composed of smooth muscle and connective tissue
•Frequently asymptomatic, females seek treatment for pelvic pressure/pain, abnormal uterine bleeding
**If suspected torsion of fibroid and hemorrhage, MEDEVAC!**

A

Leiomyoma of the Uterus (Pelvic Mass)

41
Q

•Abnormal uterine bleeding is the presenting sign in 90% of cases - all post menopausal bleeding requires evaluation

A

Endometrial Carcinoma

42
Q
  • Chronic pelvic pain and infertility, dysmenorrhea, dyspareunia, abnormal uterine bleeding, may be asymptomatic
  • Physical exam may show tender nodules in the cul de sac or rectovaginal septum, cervical motion or tenderness, adnexal mass or tenderness
A

Endometriosis

43
Q

•Lower abdominal pain, chills and fever, menstrual disturbances, purulent cervical discharge, cervical motion, cervical and adnexal tenderness, postcoital bleeding, urinary frequency and low back pain
**“•Tubo-ovarian abscess
•Pregnancy
•Unable to follow/tolerate outpatient regimen
•No response to outpatient therapy within 72 hours
•Severe illness, nausea, vomiting or high fever
•Appendicitis cannot be ruled out
MEDEVAC!”**

A

Pelvic Inflammatory Disease (PID)

44
Q
  • Benign malignant ovarian neoplasms are either asymptomatic or experience only mild nonspecific GI symptoms or pelvic pressure
  • Advanced malignant disease may experience abdominal pain and bloating, and a palpable abdominal mass with acites
A

Ovarian Mass

45
Q
  • Characterized by: chronic anovulation, polycystic ovaries, hyperandrogenism
  • Associated with: hirsutism, obesity, increased risk for diabetes and cardiovascular disease
  • Often presents with menstrual disorder ranging from amenorrhea to menorrhagia, infertility, skin disorders (secondary to increased androgens), and insulin resistance
A

Polycystic Ovarian Syndrome (PCOS)

46
Q

•Recurrent or persistent genital pain associated with sexual intercourse that is not associated with lack of lubrication or vaginismus

A

Dyspareunia

47
Q

(is the most common cause in premenopausal women)
•Characterized by sensation of burning, pain, itching, stinging, irritation, rawness and may be constant or intermittent, focal or diffuse
•Generally no physical exam findings

A

Vulvodynia dyspareunia

48
Q
  • Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse
  • Results from fear, pain, sexual violence, negative attitude towards sex
A

Vaginismus

49
Q
  • Pregnancy does not result after ONE year of normal sexual activity without contraceptives
  • Incidence increase with age
A

Infertility

50
Q

•Intentional contact characterized by the use of force, threats, intimidation, or abuse of authority or when the victim does not or cannot consent
•Rape, sexual assault, aggravated sexual assault, abusive sexual contact, forcible sodomy, or attempts to commit these offenses
**MEDEVAC**

A

Sexual Assault Patient

51
Q

•Amenorrhea, nausea and vomiting, breast tenderness and tingling, urinary frequency and urgency, ““quickening”” (perception of first movement noted at about the 18th week), weight gain
•Softening of the cervix occurs around 7 weeks - becomes bluish to purple due to the increased blood supply (Chadwick sign)
•Uterine fundus is palpable above the pubic symphysis by 12-15 weeks from the last menstrual period, reaches the umbilicus by 20-22 weeks
•Fetal heart tones can be heard by Doppler at 10-12 weeks of gestation
**MEDEVAC**

A

Intrauterine Pregnancy

52
Q

“THREATENED ABORTION
•Bleeding or cramping occurs, but the pregnancy continues; the cervix is not dilated

COMPLETE ABORTION
•Products of conception are completely expelled, pain ceases but spotting may persist; cervical os is closed

INCOMPLETE ABORTION
•The cervix is dilated, some portion of the products of conception remains in the uterus, only mild cramps are reported, bleeding is persistent and often excessive

MISSED ABORTION
•Pregnancy has ceased to develop but the conceptus has not been expelled, symptoms of pregnancy disappear, there may be a brownish vaginal discharge but no active bleeding, pain does not develop; cervix is semi firm and slightly patulous, the uterus becomes smaller and irregularly softened, the adnexa are normal

**MEDEVAC**

A

Pregnancy Loss

53
Q

•Severe lower quadrant pain that is sudden in onset, stabbing, intermittent and does not radiate
•Backache may be present during the attacks
•Adnexal tenderness on physical exam
•Shock occurs in about 10% often after pelvic examination
•At least 2/3 of patients give a history of abnormal menstruation or infertility
**MEDEVAC**

A

Ectopic Pregnanncy

54
Q
  • Frequently begins within 3 months after delivery
  • Starts with an engorged breast and a sore or fissured nipple
  • Cellulitis is typically unilateral, red, tender, and warm
  • Fever and chills are common
A

Mastitis

55
Q

“PRIMARY
•Failure of menarche to appear

SECONDARY
•Absence of menses for 3 consecutive months in women who have passed menarche (PREGNANCY)

MENOPAUSE
•Terminal episode of naturally occurring menses, usually after 6 months after amenorrhea”

**Depending on presenting factors, MEDEVAC**

A

Secondary Amenorrhea

56
Q

CLASSIC
•Sudden onset severe unilateral lower abdominal pain that may develop after episodes of exertion

ATYPICAL
•Half of patients experience gradual onset of intermittent pain with nausea and vomiting

PHYSICAL PAIN
•Unilateral lower abdominal tenderness with guarding
•Unilateral adnexal tenderness on bimanual exam
•Possible palpable adnexal mass

**MEDEVAC**

A

Ovarian Torsion

FEP MDT S/Sx's (11 decks)

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