GU/GYN Flashcards by Ryan Brown

Enuresis

Def: -1- that occurs -2- when -3- should be present

Involuntary urination
at an age
voluntary control

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Enuresis - Types
> Primary: has -1- for -2-
> Secondary: -3- months and -4-

been dry
< 6 months
Dry for 6+
begins to wet again

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Enuresis - Types
> Functional urinary -3-: -1- (formerly called -2-)
> Nocturnal enuresis: -3- during -4-

daytime wetting
diurnal enuresis
incontinence
sleep

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Enuresis - Incidence
> -1-: Up to -2-
> -3-: Up to -4-
> Most -5-

3yo
40%
7 yo
10%
cases are functional

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Enuresis - S/S
> Hx of -1-
> Assess for -2- (e.g., -3-, -4-, -5-)

bed incontinence
comorbidities
constipation
sleep apnea
ADHD

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Enuresis - Lab/Dx
> -1- (-2-, -3-)
> -4-

UA
assessing for UTI
or DM
ultrasound (masses)

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Enuresis - Mgmt
> Psychobehavioral
» -1- (-2-), positive reinforcement such as sticker chart
» -3- (-4-) (geared toward training the bladder to hold more urine)

enuresis alarm
moisture sensor
bladder control training
watch timer

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Enuresis - Mgmt
» Meds
»> -1- 25 mg qhs x 1wk
»> Desmopressin: available -2-, intranasally, no -3-
»> Oxybutinin (ditropan): for detrusor muscle hyperactivity assoc w/ -4- in children < 6 yo; 5 mg may be given BID, max 5 mg TID

Imipramine
orally
need for consistency
neuro disorders (spina bifida)

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Enuresis - Mgmt
» -1-
»> Imipramine 25 mg qhs x 1wk
»> -2-: available orally, -3-, no need for consistency
»> -4-: for detrusor muslce hyperactivity assoc w/ neuro disorders (spina bifida) in children < 6 yo; 5 mg may be given BID, max 5 mg TID

Meds
Desmopressin
intranasally
Oxybutinin (ditropan)

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Enuresis - Mgmt
> Non-pharm
>> -1- (better success rate than med use), -2-
>> -3- (-4-)
> -5-, if indicated

Hypnosis/self-hypnosis
done in voiding clinics
Parental education
“emphasis on ‘involuntary’”
Treat UTI

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Urinary Tract Infection
Def: -1- and inflammation of the -2- are more common in males (uncircumcised) in the first year of life. -3- increases at -4- throughout the lifespan.

Bacterial infections
urinary tract
Incidence in females
a 10:1 ratio

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Urinary Tract Infection
Def: Bacterial infections and -1- of the urinary tract are more common in -2- in the -3-. Increases are seen in females at a 10:1 ratio -4-.

inflammation
males (uncircumcised)
first year of life
throughout the lifespan

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Urinary Tract Infection - Causes/Incidence
> Both -1- UTIs in -2- are typically caused by the folowing organisms:
» -3-: Approximately -4- of cases
» -5-

Male and female
childhood
E. coli
85%
Staph aureus

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Urinary Tract Infection - Causes/Incidence
> Predisoposing factors include urinary stasis, -1- or -2-, and non-obstructive causes (e.g. -3-, poor hygiene, -4-, and coitus)

congeintal
acquired obstructive lesions
neurogenic bladder
constipation

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Urinary Tract Infection - Causes/Incidence

> -1- (-2-) may result in -3-, eventual HTN, and renal failure

High-grade vesicoureteral reflux
caused by repeated or poor catheterization
renal scarring

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Urinary Tract Infection - S/S
> Infants
» May have no -1- (-2- on -3- for -4-)

signs or symptoms
UTI
DDx
Fever

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Urinary Tract Infection - S/S
> Children/adolescents:
>> -1-
>> -2-
>> Suprapubic/lower -3-
>> -4-
>> -5-

Dysuria
frequency
abdominal discomfort
fever
hematuria

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Urinary Tract Infection - Lab/Dx
> -1- for culture/sensitivity indcated for those who -2- (-3- may be used for mild symptoms or follow-up)
> UA: -4- (-5-)

Straight cath
cannot voluntarily void
clean catch
Leukocytes, erythrocytes, nitrites
nitrites: septic urine

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Urinary Tract Infection - Lab/Dx
> Leukocytosis in the -1-
> -2- undergo -3- US

CBC
Febrile infants should
renal and bladder

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Urinary Tract Infection - Mgmt
> -1- for -2-
>> -3- or 
>> -4-
>> Then -5-

PO abx
1-2 weeks
Start with cephalosporins
amoxicillin/clavulanate
change re:UC results

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Urinary Tract Infection - Mgmt
> -1- in -2-; change the antibiotic if no improvement seen
> -1- in 7-10 days, then every 1-3 months for 1 year
*Note: Children -3- with a -4- should be -5- abx

Follow up
2-3 days
< 2 mo
UTI
hospitalized for parenteral

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Urinary Tract Infection - Mgmt
> Renal -1- after first UTI:
» -2-
» -3-

US
febrile infants
all children 2-24 mo

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Urinary Tract Infection - Mgmt
> -1- is indicated if -2-
> -3- is not indicated

VCUG
US is patho
Antimicrobial prophylaxis

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Hypospadias
Def: one of the most common -1- in which the -2- is not located -3- of -4-

Causes/Incidence
> The -5-; currently hypothesized to be deformity rather than a malformation

congenital birth defects
eurethral opening
at the tip
the penis
etiology is unclear

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Hypospadias - Causes/Incidence > Occurs in -1-; often -2- > Likelihood of -3- such as -4-, inguinal -5- is noted

1. 1:200 live births 2. familial 3. other GU anomalies 4. undescended testicles 5. hernia or hydrocele

Hypospadias - Types > -1-: opening -2- of the penis > -3-: opening along the shaft of the penis > -4-: opening located where the -5- meet

1. Subcoronal 2. near the head 3. Midshaft 4. Penoscrotal 5. penis and scrotum

Hypospadias - S/S > Urinary stream that -1- > -2- (-3- of the penis) > -4- (about 10% of cases)

1. isn't straight 2. Chordee 3. ventral bowing 4. undescended testicle

Hypospadias - Lab/Dx | > Diagnosis is made by...

...clinical findings

Hypospadias - Mgmt > -1- at birth > -2- may be contraversial (-3- may be -4-) > Surgery best done around -5-

1. Referral to urologist 2. Circumcision at birth 3. foreskin 4. used in repair 5. 3-18 months of age

Hydrocele Def: -1- in the sheath that -2-; common in premature males Causes/Incidence > Found in -3- of male newborns

1. fluid collection 2. surrounds the testicles 3. 80-90%

Hydrocele - Causes/Incidence > Risk factors >> Newborn: -1-, -2-, crytpoorchidism, hypospadias, -3-

1. LBW 2. preterm birth 3. CF

``` Hydrocele - Causes/Incidence > Risk factors >> Older children/adolescents >>> -2- >>> -3- >>>> epididymitis >>>> -4- >>>> -5- ```

2. Idiopathic 3. secondary 4. orchitis 5. testicular torsion/trauma

Hydrocele - Types > -1-: -2- > -3-: -4- to the -5-

1. Noncommunicating 2. sealed 3. communicating 4. open 5. abdomen (hernia is likely)

Hydrocele Signs/Symptoms > One or both -1- (-2-) Labs/Dx > Usually diagnosed on -3- > -4-

1. testicles are swollen 2. light test: transluscent 3. physical exam 4. US

Hydrocele - Mgmt/Tx > Referral -1- > -2-: usually -3- > -4-: may -5-

1. to pediatric urologist 2. noncommunicating 3. resolves spontaneously 1 yr 4. Communicating 5. require surgery (hydorcelectomy)

Cryptorchidism | Def: -1- of the testes from the -2- due to failure to descend form the abdomen in utero; referred to as a(n) -3- (-4-)

1. absence of one or both 2. scrotal sac 3. undescended testicle 4. vs. a retractile

Cryptorchidism S/S > Inability -1- > Often -2- Lab/Dx > usually diagnosed on -3-

1. to palpate testicle 2. no symptoms 3. physical exam

Cryptorchidism - Mgmt > If undescended, refer to -1- by -2- > Testicular self-exam (TSE) for -3- probability

1. peds urologist 2. 4-6 months of age 3. increased testicular cancer

Testicular Cancer Def: -1-; most common solid malignancy in men 20-35 Causes/Incidence > -2- > Peak incidence b/t -3-; begin Testicular self-exam (TSE) screenings at age 15

1. malignancy of the testicles 2. Lifetime risk: 1:250 3. 15 & 35 yo

``` Testicular Cancer - Causes/Incidence > Most common in -1-; black males have -2-, but -3- > Risk factors: >> -4- with testicular cancer >> -5- ```

1. White males 2. lower rates 3. higher risk of death 4. first-degree relative 5. crytporchidism

Testicular Cancer - Risk factors > Congenital >> -1- >> -2- (e.g., -3-)

1. Hypospadias 2. Chromosomal disorder 3. Klinefelter

Testicular Cancer - S/S > Testicle may become -1- > -2- in the -3- or scrotum > -4- (5% of patients with -5-)

1. Swollen or grow 2. Heaviness/aching 3. abdomen 4. genetic disorder 5. Klinefelter syndrome

Testicular Cancer Lab/Workup > Initially, -1- to distinguish mass from testes Tx/Mgmt > refer to -2- > Mgmt includes -3- and sometimes -4-

1. US 2. peds/urology 3. surgery 4. chemo/radiation

Testicular Torsion | Def: -1- adn strangulation of the -2- causing acute pain; constitutes a(n) -3- to prevent a(n) -4- and infertility

1. Twisting 2. spermatic cord 3. surgical emergency 4. necrotic testicle

Testicular Torsion Causes/Incidence > Occurs most often between -1- > -2- produces acute pain S/S > -3- in one testicle not caused by -4-

1. 12-18 years 2. interruption of the vascular flow 3. Sudden severe pain 4. injury or accident

Testicular Torsion - S/S > -1- on -2- of the testicle > -3- in the testicle

1. swelling 2. one side 3. visible lump

Testicular Torsion - S/S | > -1- (-2- resulting in -3- on the same side)

1. **Absent cremasteric reflex** 2. stroking of the inner thigh 3. retraction of testicle

Testicular Torsion Lab/Dx > Phys Ex, -1-, medical history > Scrotal -2- to determine presence of blood flow within the teseticular tissue may be ordered Mgmt > Refer for -3- > If not treated -4-, the testicle -5-

1. description of symptoms 2. US w/ doppler signaling 3. emergent surgical intervention 4. w/in 6 hours 5. may be lost

Dysmenorrhea Def: -1- associated w/ -2- > -3-: >> -4- of any pelvic -5-; most seen in adolescents

1. pain and cramping 2. menstruation 3. Primary 4. absence 5. pathology

Dysmenorrhea > Primary >> The etiology of primary dysmenorrhea is believed to be -1- >> Most cases of primary dysmenorrhea -2- after -3-, with symptoms -4- until patients are in their -5-

1. hormonal/endocrine-related 2. begin 6-12 months 3. menarche 4. gradually increasing 5. mid-20s

Dysmenorrhea > -1- >> results from a(n) -2- such as pregnancy, -3-, and -4-

1. Secondary 2. underlying cause 3. pelvic inflammatory disease (PID) 4. endometriosis

Dysmenorrhea - S/S > -1- > Lower abdominal pain associated with menstruation, usually worse in the -2- of bleeding (-3-) > Associated -4- > May have -5-, fatigue, HA, and diarrhea

1. Painful menses 2. first few days 3. (usually heavy bleeding at that) 4. back pain (radiates to thighs) 5. Nausea, vomiting

Dysmenorrhea - Lab/Dx > -1-: no testing is necessary; the -2- > Testing for -3-: according to -4-

1. Primary 2. diagnosis is clincal 3. Secondary dysmenorrhea 4. suspected underlying cause

``` Dysmenorrhea - Mgmt > -1-, proper -2- > -3- measures >> -4- application >> -5- ```

1. Education about menstruation 2. diet 3. supportive 4. heat 5. psychosocial support

Dysmenorrhea - Support Measures | >> OTC analgesics, preferably -1-: 400 mg -2-, beginning -3- of -4- and continuing -5-

1. ibuprofen 2. Q4-6 hours, 3. at the onset 4. menstruation 5. for 24-72 hours

Dysmenorrhea - Mgmt > -1- for -2- dysmenorrhea > -3- > -4-

1. Stronger NSAIDs (naproxen) 2. moderate to severe 3. oral contraceptives 4. referral as needed

Bacterial Vaginosis Def: a vaginal infection in which -1- of bacteria interact to -2- Causes/Incidence > -3- vaginal infection in women of -4-; may be seen in -5- as well

1. several species 2. alter the vaginal flora 3. Most prevalent 4. reproductive age 5. prepubescent females

Bacterial Vaginosis - Causes/Incidence | > -1- a(n) -2-; seen -3- in -4-

1. Not considered 2. STI 3. more often 4. sexually active women

Bacterial Vaginosis - Causes/Incidence | > More common in females who use -1-, -2- soap products, or even -3-

1. douches 2. colored or scented 3. bath bombs

Bacterial Vaginosis - S/S > May have -1- > -2- (-3- in color); most prominent around -4- or -5-

1. pruritis 2. **Malodorous "fishy" discharge** 3. thin, white to gray 4. menstruation 5. after sexual intercourse

Bacterial Vaginosis - Labs/Dx > -1- >> -2- covered with -3- (-4-) with -5-

1. Wet mount 2. **Clue cells**: epithelial cells 3. bacteria appear stippled 4. small dots or specks 5. poorly defined borders

``` Bacterial Vaginosis - Labs/Dx > Wet mount >> -1- >> -2- > -3- test (-4- when -5- added to slide) ```

1. Decreased/absent lactobacilli 2. few or absent WBCs 3. **Postive amine "whiff" test** 4. fishy odor 5. KOH

Bacterial Vaginosis - Tx > -1- >> -2- and -3-: 500 mg BID x 7 days OR > -4-: >> -1- (0.75%), one applicator (5g)/day x 5 days OR >> -5- (2%), one applicator (5g) QHS x 7 days

1. Metronidazole 2. Children > 45 kg 3. Adolescents 4. Intravaginal 5. clindamycin

Hyperkalemia The most common cause of hyperkalemia in infants and children is -1-, which refers to an elevated -2- on a laboratory test when the -3- -2- in the -4-. This phenomenon may arise from -5-.

1. pseudo-hyperkalemia 2. serum potassium concentration 3. actual 4. blood is normal 5. tourniquet-related hemolysis (and other mechanical factors such as traumatic venipuncture/probing, small catheter diameters, excessive syringe force)

Hyperkalemia -1- may also occur secondary to -2- including -3-. Samples obtained via -4- in young infants are particularly susceptible to -5-.

1. pseudo-hyperkalemia 2. hematologic abnormalities 3. leukocytosis or thrombocytosis 4. heelstick 5. hemolysis

Hyperkalemia When -1- is suspected, such as in the case of a child without -2- for hyperkalemia, a -3- should be obtained from a -4- before any -5-.

1. pseudo-hyperkalemia 2. symptoms or risk factors 3. new specimen 4. free-flowing venous sample 5. treatment is administered

Hyperkalemia -1- hyperkalemia is typically associated with: -2- associated with -3-, extensive traumatic injuries, or in the presence of -4-; or with increased exogenous intake of potassium either through diet or supplementation, -5- or gastrointestinal bleeding.

1. True 2. inadequate excretion of potassium 3. renal dysfunction 4. significant acidosis 5. blood transfusions, poisoning

Hyperkalemia A number of medications including -1-, and -2- can increase serum potassium levels. -3- is unlikely to cause significant increase in serum potassium levels.

1. NSAIDs, potassium-sparing diuretics 2. trimethoprim 3. Dietary potassium

Epididymitis, or inflammation of the epididymis, occurs most frequently in -1- and -2-, usually due to -3-.

1. late adolescence 2. early adulthood 3. bacterial infection

In -1-, the most common etiologies of epididymitis are -2-; in males who practice -3-, it may additionally be caused by -4- such as -5-.

1. heterosexual men 2. gonorrhea and chlamydia 3. insertive anal sex 4. enteric organisms 5. E. coli

Epididymitis presents typically with a gradual onset of -1-, -2-, and a -3-, indurated, and hard epididymis. -3-from epididymitis may be relieved with -4-, while in testicular torsion the symptoms present more acutely, and -4- makes -3- much -5-.

1. redness 2. scrotal swelling 3. tender/pain 4. scrotal elevation 5. worse

Varicoceles are -1- causing a painless mass in the -2-that often is described by the patient as feeling like “a -3-;” with prolonged standing activity, there can be increased -4- which is relieved when the individual -5-.

1. enlarged vessels 2. scrotum 3. bag of worms 4. dull aching pain 5. reclines

An inguinal hernia presents as a -1- in the inguinal area or scrotum -2- passing through a weakness in the -3-. A painful hernia is typically -4-, while a non--4- hernia can be -5-.

1. swelling 2. containing abdominal contents 3. abdominal wall 4. incarcerated 5. reduced

Primary nocturnal enuresis is a common problem in children between the ages of -1- years. In most cases, the symptoms will be -2-. Once any medical or physical problem is ruled out, -3- include limiting fluids after dinner, encouraging urination -4-, and holding the urine for -5- during the day.

1. 5 and 8 2. outgrown without treatment 3. common sense approaches 4. right before sleep 5. longer periods

Primary Nocturnal Enuresis Common sense approaches do -1- in many cases and should be the -2- given to families. Active treatment should not occur -3-, and punitive -4- to prevent harm to the child’s self-esteem. Alarm systems work well in waking the child when the first few drops of urine are sensed and are considered -5-.

1. help 2. first counseling information 3. before age 6 4. consequences are avoided 5. first line treatment

Primary Nocturnal Enuresis Alarm systems have -1- than medications. Medications like -2- are also effective as long as they are used regularly, but -3- when they are stopped.

1. lower relapse rates 2. DDAVP and imipramine 3. relapses can occur

Male Genital Examination The inability to retract the foreskin is normal until -1- of age. It is common for the -2- during an examination or to -3- in infancy and early childhood. In this age group placing a finger above the -4- and “milking down” the testis into the scrotum -5-.

1. about 6 years 2. testis to retract 3. cold or touch 4. inguinal canal 5. prevents this retraction

Male Genital Examination Medical terminology for the whitish matter under the foreskin of the penis is -1-, and it is a -2-. A hydrocele is a -3- containing serous fluid. A hydrocele can further be classified as -4-.

1. smegma 2. normal body substance 3. scrotal sac enlargement 4. non-communicating or communicating

Hydrocele In a -1-, the scrotum is tense and non-reducible, the fluid does not fluctuate, and the hydrocele will -2-. A -3- is reducible, has a fluctuating fluid volume, and is more often associated with hernias. Therefore, if they persist -4-, -5- is warranted.

1. non-communicating hydrocele 2. resolve without intervention 3. communicating hydrocele(s) 4. at 1 year (12 months) 5. referral for surgery

A newborn with hypospadias must be referred to a -1- at -2-. One with an undescended testicle must be referred to a -1- in -3- to determine the course of treatment. Additionally, -4- abnormalities is indicated if the newborn has bilateral cryptochordism, and is -5- for a single undescended testicle.

1. urologist 2. birth 3. a year 4. karyotyping for chromosomal 5. typically not necessary

-1- such as -2- are highly unlikely to be responsible for a patient's UTI. -1- cause UTIs but are not as common as -3- such as -4-, -5-, and -6- which are the most common bacterial agents responsible for UTIs.

1. Gram-positive bacteria 2. Enterococcus faecalis 3. Gram-negative bacteria 4. Escherichia coli 5. Klebsiella 6. Proteus