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Clinical Medicine LAB - Professor Sample > GU #3 > Flashcards

GU #3 Flashcards

1
Q

Chlamydia trachomatis indications?

A

Concern for STD
Symptoms of pelvic pain
vaginal dc
dysuria

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2
Q

Most prevalent STD in the US?

A

Chlamydia trachomatis

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3
Q

Chlamydia trachomatis is most prevalent in ?

A

Most prevalent in those < 20 yo, nulliparous, and those having unprotected intercourse

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4
Q

women with Chlamydia trachomatis infection can ba ?

A

a sxs. for a long time

could have been old boyfriend

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5
Q

Chlamydia trachomatis can be associated with ?

A

concomitant gonorrhea infection -

they usually go hand in hand with unprotected sex risk factor

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6
Q

Chlamydia Trachomatis gold standard?

A

Cell culture:

Most accurate
Difficult to grow
Time consuming
expensive

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7
Q

Chlamydia Trachomatis serum ABS testing evaluates for ?

A

IgG ABS

More helpful when concerned about other types of chlamydia infxn

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8
Q

Chlamydia Trachomatis serum ABS testing needs?

A

acute and convalescent samples (watch for rise in titer)

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9
Q

What is dx when using serum ABS testing for Chlamydia?

A

4 fold rise in IgG or +IgM is diagnostic of acute infection

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10
Q

Chlamydia Trachomatis nucleic acid probes are the ?

A

most common

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11
Q

What probes does the nucleic acid probe testing use when testing for Chlamydia?

A

DFA
ELISA
DNA probes

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12
Q

What chlamydia test is less expensive and more widely available ?

A

Less expensive and more widely available than others

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13
Q

Whats lower for nucleic acid probes than for culture?

A

Sensitivity and specificity are lower than culture

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14
Q

Neisseria gonorrhoeae (Gonorrhea) normal values?

A

no growth

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15
Q

Neisseria gonorrhoeae (Gonorrhea) indications?

A

Penile/vaginal dc
Pelvic pain ( PID)
Urethritis
Concern for STD

**copious green purulent discharge*

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16
Q

Gonorrhea gram stain?

A

Gram negative diplococcci

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17
Q

Gonorrhea Gold standard?

A

Culture

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18
Q

What agar is used when culturing gonorrhea ?

A

Thayer-Martin agar is selective for Neisseria,

chocolate agar can be used as well

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19
Q

Gonorrhea Nucleic acid probes?

A

this is the one that you do , this is most common

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20
Q

Gonorrhea Nucleic acid probes used what type of probe?

A

DNA

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21
Q

For gonorrhea testing: what is less expensive the culture?

A

Nucleic Acid Probes

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22
Q

What can be performed on urine for chlamydia or gonorrhea?

A

Nucleic acid amplification test (NAAT)

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23
Q

Testing a chlamydia and gonorrhdsa in kis?

A

testing a young child - more urine screens

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24
Q

Urethritis Specimen Collection procedure?

A

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*

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25
Q

Female Specimen Collection?

A

Cervical mucous is removed

Endocervical swab is placed in the endocervical canal and rotated

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26
Q

What can skew gonorrhea and chlaymdia results ?

A

just urinated or douched

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27
Q

other locations and specimen collection sites for G and C?

A

Anal Canal Cultures

Oropharyngeal cultures

Urine tests

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28
Q

Obtaining specimens for G and C considerations?

A

Menses may alter test results

Males voiding within 1 hour before the test

Fecal material

Female douching within 24 hours

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29
Q

Saline wet mount useful in identifying?

A

Trichomonas

Bacterial Vaginosis (BV)

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30
Q

Saline wet mount technique?

A

Glass slide

Sample of discharge

2-3 gtts of sterile saline

Observe for motile trichomonads or clue cells

Important to get a fresh specimen

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31
Q

Trichomoniasis vaginitis characterized by?

A

frothy vaginal dc
odor
itching

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32
Q

Trichomoniasis vaginitis PE?

A

shows vulva erythema vaginal erythema
petechial mottling

** strawberry cervic *

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33
Q

Trichomoniasis vaginitis under microscopy?

A

mobile flaguloits

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34
Q

Bacterial vaginosis (BV) characterized by ?

A

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

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35
Q

BV what are clue cells?

A

vaginal epithelial cells with bacteria stuck to them - clue cells

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36
Q

BV tx?

A

metronizaole

no ETOH cause they will vomit copiously

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37
Q

G and C tx?

A

z pack, ceftianone

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38
Q

KOH prep is?

A

potassium hydroxide

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39
Q

KOH prep useful in evaluating what ?

A

yeast vaginitis (Candidiasis)

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40
Q

KOH prep technique?

A

Glass slide

Sample of dc

2-3 gtts of KOH
will dissolve epithelial cells

Observe for yeast cells

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41
Q

Herpes simplex virus (HSV) indications?

A

Diagnose acute HSV infections

Fever of unknown origin in immunocompromised patients

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42
Q

Herpes simplex virus (HSV) normal values?

A

No virus present

No HSV antigens or antibodies present

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43
Q

HSV can be classified as?

A

Type 1 or Type 2

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44
Q

HSV: Infants can be infected as they pass through the _____ _____

A

birth canal

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45
Q

What is not a useful test in adults with HSV?

A

Serum antibody testing is not useful in adults!

  • Most have antibodies
    b/c most have the ABS from cold sores etc HSV II etc, **
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46
Q

HSV PE?

A

shallow
small and painful
shallow ulcerations

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47
Q

HSV gold standard?

A

culture

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48
Q

HSV culture and ID in ___ of infected patients

A

90%

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49
Q

HSV Tzanck smear?

A

Scraping of the ulcer to look for multinucleated giant cells

Cannot differentiate between HSV viruses

50
Q

HSV antigen testing?

A

Flourescent immnuoassay

Latex agglutination

Results can be available within one day

51
Q

HSV antibody testing?

A

> 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 **
52
Q

HSV obtaining specimens ?

A

Culture of a vesicle should be done on an unroofed lesion

*unroof lesions and get fluid from vesicle **

53
Q

HSV urethral culture?

A

Same procedure as GC culture

54
Q

HSV cervical culture?

A

Same procedure as GC culture

55
Q

HSV for pregnant patients?

A

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.

56
Q

HPV indications?

A

Identify genital HPV infection in a female with an abnormal Pap smear

57
Q

HPV normal values?

A

No HPV present

58
Q

HPA causes?

A

causes cervical CA and genital warts

** HPV reflex test from an abnormal pap with irregular cells *

59
Q

HPV is a ?

A

DNA tumor virus

60
Q

HPV MOA?

A

HPV DNA incorporates itself into the cervical cell genome activating oncogenes and suppressing the cell immune response

61
Q

HPA low risk ?

A

HPV 6,11

62
Q

HPV low risk is associated with ?

A

genital warts and low grade dysplasia

63
Q

HPV high risk ?

A

16

18

64
Q

HPV high risk is associated with ?

A

severe lesions and cervical cancer

** 16 and 18 are in the gardisil vaccine **

65
Q

HPV vaccines are for ?

A

6,11,16, and 18

66
Q

HPV is a __ injection

A

IM

67
Q

What ages should get the HPV vaccine?

A

Males and Females age 9-26

68
Q

HPV is a series of _ shots?

A

3

69
Q

HPV series order?

A

1st
2nd-2 mos later
3rd-6 mos after the 1st

70
Q

Syphillis is what type of organism?

A

Spirochete Treponema pallidum

71
Q

Syphillis 4 stages?

A

Acute
Secondary
Latent
Tertiary

72
Q

Syphillis does not grow on?

A

artificial medium

73
Q

Syphilis dx test?

A

DFM - Dark field microscopy

74
Q

Syphillis DFM what to look for?

A

T. pallidum morphology and motility

75
Q

DFM advantage?

A

Definitive immediate diagnosis

Rapid results

76
Q

DFM disadvantages?

A

Requires specialized equipment and an experienced microscopist

Possible confusion with other pathogenic and nonpathogenic spirochetes

Must be performed immediately

Possibility of false-negatives

77
Q

Syphilis non-treponemal tests detects presence of ?

A

reagin

78
Q

Non-treponemal tests reacts with ____________ in the body similar to those of T. pallidum

A

phospholipids

79
Q

Non-treponemal tests are more for ?

A

screening

non specific

80
Q

Non-treponemal tests examples?

A

VDRL

RPR

81
Q

Syphillis Treponemal tests detects ?

A

Ab against treponema organism

82
Q

Treponemal tests are usually reactive for how long?

A

life

83
Q

Treponemal tests are used for ?

A

confirmatory tests

84
Q

Treponemal tests examples?

A

FTA-ABS

MHA-TP

85
Q

Imaging stone protocol ?

A

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 *

86
Q

Cystoscopy is ?

A

Endoscopic test to evaluate the urethra, bladder, and lower ureters.

87
Q

Cystoscopy provides ?

A

visualization

88
Q

Cystoscopy indications?

A

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 *

89
Q

Cystoscopy diagnostic?

A

Inspection and biopsy

Urine specimen from individual ureters

Determine ureteral reflux

Placement of ureteral catheters or stents

ID source of hematuria

90
Q

Cystoscopy Therapeutic ?

A

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 *

91
Q

Cystoscopy complications?

A

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

92
Q

Cystoscopy homecare instructions?

A

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

93
Q

IVP indications?

A

✪ Most common test for eval of the urinary system

94
Q

IVP is indicated in patients with ?

A 
Trauma
Urinary outlet obstruction
Suspected kidney tumor
Hematuria
Pain compatible with stones
95
Q

IVP what is it ?

A

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

96
Q

IVP: IV contrast is injected to allow visualization of the ___________

A

urinary system

97
Q

IVP: X-rays are taken in set intervals over the next __ min?

A

30 minutes

98
Q

IVP: real phase?

A

Best visualizes the kidney

99
Q

IVP: collecting phase?

A

Better to see the calyces, ureters and bladder

100
Q

IVP contraindications?

A

Renal insufficiency

Allergies to dye

Pts with severe dehydration

Pregnant patients - radiation hurts fetus
elevated Cr

101
Q

IVP complications?

A

Renal failure

Infiltration of the dye

Allergic reaction

102
Q

IVP considerations?

A

No Metformin for 24 hours after IV dye

103
Q

Cystography aka?

A

Voiding cystourethrogram (VCUG)

104
Q

Cystography MOA?

A

Fill bladder with dye

Take images as bladder empties

**CVUG - fill bladder with dye and take images as the bladder empties *

105
Q

VCUG: bladder tumors?

A

Filling defect or shadow

106
Q

VCUG: pelvic tumor?

A

Extrinsic compression or distortion of shape of the bladder

107
Q

VCUG: Traumatic rupture or perforation?

A

Extravasation of dye ( DUH!)

108
Q

VCUG: Vesico-ureteral reflux?

A

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. *

109
Q

Uroflowmetry measures the ____ of urine flow during micturation

A

rate

110
Q

Uroflowmetry Normal values depend on?

A

age
gender
volume voided

111
Q

Uroflowmetry is useful in dx?

A

outflow obstruction

112
Q

Uroflowmetry indications?

A

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

113
Q

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?

A

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

114
Q

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?

A

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

115
Q

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?

A

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

116
Q 
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?
A

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

117
Q

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?

A

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

118
Q

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?

A

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

119
Q

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?

A

nephrotic syndrome

What test should you do for confirmation?
over 3 g of protein in a 24 hours urine, minimal change disease

120
Q

A 78-year-old woman is brought in for a change in MS.

what is the first test to run?

A

UA - change in mental status

CT brain - stroke maybe cause she has mental status change, confusion, delirium

Clinical Medicine LAB - Professor Sample (36 decks)

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