GU #3 Flashcards
Chlamydia trachomatis indications?
Concern for STD
Symptoms of pelvic pain
vaginal dc
dysuria
Most prevalent STD in the US?
Chlamydia trachomatis
Chlamydia trachomatis is most prevalent in ?
Most prevalent in those < 20 yo, nulliparous, and those having unprotected intercourse
women with Chlamydia trachomatis infection can ba ?
a sxs. for a long time
could have been old boyfriend
Chlamydia trachomatis can be associated with ?
concomitant gonorrhea infection -
they usually go hand in hand with unprotected sex risk factor
Chlamydia Trachomatis gold standard?
Cell culture:
Most accurate
Difficult to grow
Time consuming
expensive
Chlamydia Trachomatis serum ABS testing evaluates for ?
IgG ABS
More helpful when concerned about other types of chlamydia infxn
Chlamydia Trachomatis serum ABS testing needs?
acute and convalescent samples (watch for rise in titer)
What is dx when using serum ABS testing for Chlamydia?
4 fold rise in IgG or +IgM is diagnostic of acute infection
Chlamydia Trachomatis nucleic acid probes are the ?
most common
What probes does the nucleic acid probe testing use when testing for Chlamydia?
DFA
ELISA
DNA probes
What chlamydia test is less expensive and more widely available ?
Less expensive and more widely available than others
Whats lower for nucleic acid probes than for culture?
Sensitivity and specificity are lower than culture
Neisseria gonorrhoeae (Gonorrhea) normal values?
no growth
Neisseria gonorrhoeae (Gonorrhea) indications?
Penile/vaginal dc
Pelvic pain ( PID)
Urethritis
Concern for STD
**copious green purulent discharge*
Gonorrhea gram stain?
Gram negative diplococcci
Gonorrhea Gold standard?
Culture
What agar is used when culturing gonorrhea ?
Thayer-Martin agar is selective for Neisseria,
chocolate agar can be used as well
Gonorrhea Nucleic acid probes?
this is the one that you do , this is most common
Gonorrhea Nucleic acid probes used what type of probe?
DNA
For gonorrhea testing: what is less expensive the culture?
Nucleic Acid Probes
What can be performed on urine for chlamydia or gonorrhea?
Nucleic acid amplification test (NAAT)
Testing a chlamydia and gonorrhdsa in kis?
testing a young child - more urine screens
Urethritis Specimen Collection procedure?
Place pt in supine position
Hold the penis at a 90 degree angle
Insert swab 2-3 cm into the urethra gently and rotate a full turn
**not comfortable, tell them this, put it send, spin it around, and send it off*
Female Specimen Collection?
Cervical mucous is removed
Endocervical swab is placed in the endocervical canal and rotated
What can skew gonorrhea and chlaymdia results ?
just urinated or douched
other locations and specimen collection sites for G and C?
Anal Canal Cultures
Oropharyngeal cultures
Urine tests
Obtaining specimens for G and C considerations?
Menses may alter test results
Males voiding within 1 hour before the test
Fecal material
Female douching within 24 hours
Saline wet mount useful in identifying?
Trichomonas
Bacterial Vaginosis (BV)
Saline wet mount technique?
Glass slide
Sample of discharge
2-3 gtts of sterile saline
Observe for motile trichomonads or clue cells
Important to get a fresh specimen
Trichomoniasis vaginitis characterized by?
frothy vaginal dc
odor
itching
Trichomoniasis vaginitis PE?
shows vulva erythema vaginal erythema
petechial mottling
** strawberry cervic *
Trichomoniasis vaginitis under microscopy?
mobile flaguloits
Bacterial vaginosis (BV) characterized by ?
malodorous gray or white dc with normal vulva and vaginal findings
**grey or white d/c bt it has a strong isscy odor worse after intercourse and urinations , opportunistic =unistic bacterial overgrowth , not a STD , just a bacteria and yeast mis balance
BV what are clue cells?
vaginal epithelial cells with bacteria stuck to them - clue cells
BV tx?
metronizaole
no ETOH cause they will vomit copiously
G and C tx?
z pack, ceftianone
KOH prep is?
potassium hydroxide
KOH prep useful in evaluating what ?
yeast vaginitis (Candidiasis)
KOH prep technique?
Glass slide
Sample of dc
2-3 gtts of KOH
will dissolve epithelial cells
Observe for yeast cells
Herpes simplex virus (HSV) indications?
Diagnose acute HSV infections
Fever of unknown origin in immunocompromised patients
Herpes simplex virus (HSV) normal values?
No virus present
No HSV antigens or antibodies present
HSV can be classified as?
Type 1 or Type 2
HSV: Infants can be infected as they pass through the _____ _____
birth canal
What is not a useful test in adults with HSV?
Serum antibody testing is not useful in adults!
- Most have antibodies
b/c most have the ABS from cold sores etc HSV II etc, **
HSV PE?
shallow
small and painful
shallow ulcerations
HSV gold standard?
culture
HSV culture and ID in ___ of infected patients
90%
HSV Tzanck smear?
Scraping of the ulcer to look for multinucleated giant cells
Cannot differentiate between HSV viruses
HSV antigen testing?
Flourescent immnuoassay
Latex agglutination
Results can be available within one day
HSV antibody testing?
> 50% of people in the US have +herpes Ab
Require acute and convalescent samples
A 4 fold rise in titers 2 weeks apart is diagnostic
Cannot distinguish between acute infection or reactivation
Immunoflourescent immunoassay
ELISA
- most he time you going to send off a culture **
HSV obtaining specimens ?
Culture of a vesicle should be done on an unroofed lesion
*unroof lesions and get fluid from vesicle **
HSV urethral culture?
Same procedure as GC culture
HSV cervical culture?
Same procedure as GC culture
HSV for pregnant patients?
Cervix is cultured weekly 4-6 weeks before delivery
Vaginal delivery is possible if:
2 most recent cultures are negative
No symptoms
No lesions are visible
Throughout the pregnancy there has been no more than one positive culture in which the woman had no symptoms.
HPV indications?
Identify genital HPV infection in a female with an abnormal Pap smear
HPV normal values?
No HPV present
HPA causes?
causes cervical CA and genital warts
** HPV reflex test from an abnormal pap with irregular cells *
HPV is a ?
DNA tumor virus
HPV MOA?
HPV DNA incorporates itself into the cervical cell genome activating oncogenes and suppressing the cell immune response
HPA low risk ?
HPV 6,11
HPV low risk is associated with ?
genital warts and low grade dysplasia
HPV high risk ?
16
18
HPV high risk is associated with ?
severe lesions and cervical cancer
** 16 and 18 are in the gardisil vaccine **
HPV vaccines are for ?
6,11,16, and 18
HPV is a __ injection
IM
What ages should get the HPV vaccine?
Males and Females age 9-26
HPV is a series of _ shots?
3
HPV series order?
1st
2nd-2 mos later
3rd-6 mos after the 1st
Syphillis is what type of organism?
Spirochete Treponema pallidum
Syphillis 4 stages?
Acute
Secondary
Latent
Tertiary
Syphillis does not grow on?
artificial medium
Syphilis dx test?
DFM - Dark field microscopy
Syphillis DFM what to look for?
T. pallidum morphology and motility
DFM advantage?
Definitive immediate diagnosis
Rapid results
DFM disadvantages?
Requires specialized equipment and an experienced microscopist
Possible confusion with other pathogenic and nonpathogenic spirochetes
Must be performed immediately
Possibility of false-negatives
Syphilis non-treponemal tests detects presence of ?
reagin
Non-treponemal tests reacts with ____________ in the body similar to those of T. pallidum
phospholipids
Non-treponemal tests are more for ?
screening
non specific
Non-treponemal tests examples?
VDRL
RPR
Syphillis Treponemal tests detects ?
Ab against treponema organism
Treponemal tests are usually reactive for how long?
life
Treponemal tests are used for ?
confirmatory tests
Treponemal tests examples?
FTA-ABS
MHA-TP
Imaging stone protocol ?
CT abdomen w/o contrast
**with contrasts obscures stones, CT flank or CT abdomen and pelvis without contrast if you are looking for a stone *
Cystoscopy is ?
Endoscopic test to evaluate the urethra, bladder, and lower ureters.
Cystoscopy provides ?
visualization
Cystoscopy indications?
Hematuria
Recurrent UTI or resistant
UTI
Urinary sxs: dysuria, urgency, retention, urgency
**directly visualize into the bladder looking for CA, recurrent UTI or urinary sxs. or painless hematuria then do this *
Cystoscopy diagnostic?
Inspection and biopsy
Urine specimen from individual ureters
Determine ureteral reflux
Placement of ureteral catheters or stents
ID source of hematuria
Cystoscopy Therapeutic ?
Resection of tumor
Removal of FB or stone
Dilation of urethra or ureter
Placement of stents
Coagulation of bleeding areas
TURP - for BPH or prostate CA
**test each ureters urine and determine which kidney they need to investigate - localize where the problem is *
Cystoscopy complications?
Perforation of the bladder
Sepsis - infections
Hematuria - trauma , bleeding
Urinary retention - just by introducing scope to a part in the body where it should not go , scope stops everything from working for a while sometimes
Cystoscopy homecare instructions?
Watch for urinary retention
Watch for passing clots
Report increasing abd pain - think perforation
Pt may experience bladder spasms - from irritation of the bladder muscle or bladder wall
Drink large amounts of fuids
Watch for fever or chills
IVP indications?
✪ Most common test for eval of the urinary system
IVP is indicated in patients with ?
Trauma Urinary outlet obstruction Suspected kidney tumor Hematuria Pain compatible with stones
IVP what is it ?
contrast into the kidney and snap images at the constant moves through the kidneys - ( allow visualization of the urinary system) , like barium we looking for filling defects, strictures, tumors etc this is like the same thing
IVP: IV contrast is injected to allow visualization of the ___________
urinary system
IVP: X-rays are taken in set intervals over the next __ min?
30 minutes
IVP: real phase?
Best visualizes the kidney
IVP: collecting phase?
Better to see the calyces, ureters and bladder
IVP contraindications?
Renal insufficiency
Allergies to dye
Pts with severe dehydration
Pregnant patients - radiation hurts fetus
elevated Cr
IVP complications?
Renal failure
Infiltration of the dye
Allergic reaction
IVP considerations?
No Metformin for 24 hours after IV dye
Cystography aka?
Voiding cystourethrogram (VCUG)
Cystography MOA?
Fill bladder with dye
Take images as bladder empties
**CVUG - fill bladder with dye and take images as the bladder empties *
VCUG: bladder tumors?
Filling defect or shadow
VCUG: pelvic tumor?
Extrinsic compression or distortion of shape of the bladder
VCUG: Traumatic rupture or perforation?
Extravasation of dye ( DUH!)
VCUG: Vesico-ureteral reflux?
As bladder is filled, jet of dye goes into the ureter
this si where VCUG is most commonly used
**as bladder is filled with dye the see a jet of dye that shoots back up into the ureter - tis is common in kids , urine sits in bladder and they can get a UTI and then it shoots back up the ureter and can cause kidney infections etc. *
Uroflowmetry measures the ____ of urine flow during micturation
rate
Uroflowmetry Normal values depend on?
age
gender
volume voided
Uroflowmetry is useful in dx?
outflow obstruction
Uroflowmetry indications?
problems with relaxation of the sphincter , or pain etc then measure the out flow of urine with this exam
decrease volume during beginning of urinartion and then it ramps up etc
A 17-year-old boy is brought in by his mother with severe testicular pain. He is tearful and begins vomiting after you examine him. On PE, the right testicle is exquisitely tender and looks to be high-lying. What test should be ordered?
Testes US - cause testeicular portion and twist it outwards and lateral toward the thigh
we have 6 hours to fix it until the testes dies
A 52-year-old woman presents to the office with complaints of urine leaking at inappropriate times. She states that she is embarassed because when she feels the urge to get to the bathroom and urinate, she often doesn’t make it there in time. What do you do?
functional incontincence: inability to get to the toilet with confusion
this lady knows she has to go but she cant get there - this is URGE incontinence ( tx - oxbuylin)
stress incontience tx - kegels, TVT
get a UZ make sure there is no infection there or hematuria or bladder CA causing issues then we go to tx
A 2-year-old girl is brought in by her mother with concerns of constipation and abdominal distention. She says that she hasn’t had a BM for 2 days and she has been eating less. The child appears non-toxic and is drinking a sippy cup while sitting on the cot. PE reveals a hard, distended abdomen and decreased bowel sounds. What next?
X ray - wilhms tumor
healthy looking kid with abd distention and mass in abd that does not bother them
kidney tumor and it does not bother them, they can get extremely large and displace the bowel
occurs mostly with developmental cells
US is dx study - clin med - less radiate and mor information ( can tell where the tumor is arising from), not as much information with a CT
A 37-year-old man presents with N/V and abd pain x 3 days. He has a hx of drug and ETOH abuse. No meds. Na: 152 - high K: 2.8 - low BUN: 96 - high Cr:3.7 - high BUN:Cr ration is greater then 21 Glu: 756 - high Amy: 256 - high Lip:420- high UA: hyaline casts, glucose, ketones What will urine osmolality be? What will urine sodium be?
he has AKI and it is prerenal cause ratio is >21 , he is diabetic , and has ketoacidosis, and has pancreatitis cause the N/V and abd pain,
What will urine osmolality be? high ( cause prerenal AKI)
What will urine sodium be? low ( prerenal condition) dehydrated and decreased blood flow to the kidneys
A 24-year-old woman is hospitalized for sepsis and is being given Gentamicin. She develops oliguria and labs are done showing an increased creatinine of 2.7 and a BUN of 31. A UA is done that shows renal tubular casts. Urine Na levels are elevated. What is the most likely diagnosis?
intrinsic AKI from gentamicin (aminoglycoside- cause nephron toxicity from tubular necrosis and theyn you get tubular casts)
BUN: Cr = <15 so intrinsic AKI
tx: stop the gent, give them fluids
A 6-year-old girl is brought in for blood in the urine. Mother noticed earlier today. A UA shows blood and her BP is noted to be elevated. UA micro shows RBC casts.
What should you ask?
What tests next?
keep eye on BP and may need Bx
What should you ask? have you had strep, fever, recent illness, this could be glomerular nephritis
What tests next? - ASO ABS and a strep culture
A 10-year-old boy is brought in for facial edema, abdominal distention, and scrotal swelling. A UA shows markedly elevated protein. Serum studies show low albumin. What is the diagnosis?
What test should you do for confirmation?
nephrotic syndrome
What test should you do for confirmation?
over 3 g of protein in a 24 hours urine, minimal change disease
A 78-year-old woman is brought in for a change in MS.
what is the first test to run?
UA - change in mental status
CT brain - stroke maybe cause she has mental status change, confusion, delirium
