GU/GYN Flashcards
Dx criteria for candida
Vaginal pH-
Treatment of candida
1st choice vaginal insert med
-azole antifungal, oral (Diflucan), vaginal (miconazole, terconazole)
Dx criteria of bacterial vaginosis
Vaginal pH- >4.5
Thin, homogeneous, white/gray discharge
Positive Whiff test-fishy odor
>20 clue cells, few or no WBC’s
Treatment of bacterial vaginosis
Metronidazole (topical Metrogel), or oral Flagyl.
Clindamycin vaginal cream or ovules (Cleocin)
Dx criteria for atrophic vaginitis
Vaginal pH- >5
Scant, white-clear discharge
Few or absent lactobacilli
Sx-itching/burning but often without sx
Treatment of atrophic vaginitis
Topical and/or vaginal estrogen if sx are recurrent or if recurrent UTI
Ex- Premarin cream (conjugated estrogen), estrace cream
Acute, uncomplicated UTI treatment
Primary- TMP/SMX-DS x 3days, nitrofurantoin (Macrobid) 100mg BID x5days or fosfomycin (Monurol) 3gram X1 dose
*all with pyridium (phenazopyridine)
Alternative tx for UTI (for e-coli resistance to Bactrim or sulfa allergy)
Ciprofloxacin 250mg BID, ciprofloxacin ER 500mg QD, Levofloxacin 250mg QD, Moxifloxacin 400mg QD, (all x 3days plus pyridium)
Epididymoorchitis definition
Organisms?
Upper reproductive tract infection with inflammation of epididymis/testis
35= enterobacteriaceae
Tx of epididymoorchitis
35- Levofloxacin 500mg po QD or Ofloxacin 300mg po BID for 10 days.
Prehn’s test
Relief of discomfort with scrotal elevation
Organisms with acute bacterial prostatitis?
35- Enterobacteriaceae
Treatment of acute bacterial prostatitis?
35- ciprofloxacin 500mg po BID or Ofloxacin 200mg po for 14 days
Urge incontinence sx/tx
Reports of strong sensation of needing to void.
Tx- anticholinergics=tolterodine (Detrol), oxybutynin (Ditropan), solifenacin succinate (Vesicare)
Stress incontinence sx/tx
Associated with lifting
Tx- support with use of vaginal tampon, urethral stents, and pessary use. Kegel exercises, pelvic floor rehabilitation and bladder training. Surgical intervention in select patients.
Functional incontinence sx/tx
Often occurs in presence of mobility problems
Tx- Ameliorated by having assistant who is aware of voiding cues available to help with toileting.
Transient incontinence sx/tx
Occurs during an acute illness
Tx- treat underlying process, discontinuation of offending medications.
Phimosis
The foreskin cannot be pulled back to expose the glans
Paraphimosis
Retracted foreskin that cannot be brought forward to cover the glans
Variocele
A palpable “bag of worms” scrotal mass that is only evident in standing position.
Hydrocele
Collection of serous fluid that causes painless scrotal swelling easily recognized by transillumination
Testicular torsion
Scrotal pain and loss of the cremasteric reflex
Cryptochidism
Testicle located in inguinal canal or abdomen
Anticholinergics/Antispasmodics action and examples
Action- relaxes bladder smooth muscle, inhibits involuntary detrusor muscle contractions
Ex- tolterodine (Detrol LA)
Oxybutynin (Ditropan XL)
Solifenacin (Vesicare)
Alpha-1 adrenergic blocking agents action and examples
Selectively antagonizes prostate alpha adrenergic receptors relaxing smooth muscle and improving urine flow.
Ex- tamsulosin hydrochloride (Flomax)
Terazosin hydrochloride (Hytrin)
Doxazosin mesylate (Cardura)
Causes of hematuria
Isolated- bleed anywhere from renal pelvis to the urethra.
RBC casts- injury to nephron.
Gross hematuria- acute cystitis, urethritis.
Proteinuria and hematuria- glomerular or interstitial nephritis.
Colicky flank pain- urethral stones
Meds/foods that may cause hematuria or act as bladder irritants
Meds- beta-lactam antibiotics, sulfonamides, NSAIDS, rifampin, cipro, zyloprim, Tagamet, Dilantin, anticoagulants.
Foods- caffeine, spices, chocolate, ETOH, citrus, soy sauce
Causes of proteinuria
If more than 2g in 24 hrs, glomerular cause is most likely.
Benign functional- orthostatic proteinuria, environmental conditions, fever, acute illness.
*When found in a low-risk patient, urine should be tested for Bence-Jones protein (associated with multiple myeloma)
Proteinuria 3-3.5 g/day is inductive of what condition?
Nephrotic syndrome
Nephrotic syndrome definition
Syndrome in which protein is lost through the kidney (proteinuria), this causes low protein in the blood (hypoalbuminemia), this causes water to shift to soft tissue (edema).
*refer to nephrology
Pyelonephritis definition
Upper UTI, infection of the kidney, characterized by infection within the renal pelvis, tubules or interstitial tissue.
Acute- infection ascending from the bladder
Chronic- usually no specific pathological explanation
UA findings with pyelonephritis
Positive bacteria, proteinuria, leukocyte esterase, urinary nitrates, hematuria, pyuria, and WBC casts.
What finding can help differentiate pyelonephritis from cystitis?
WBC casts. This is seen with pyelonephritis and it indicates inflammation of the kidney- such casts will not form except in the kidney.
What “zone” does BPH develop? CA develop?
BPH- transitional zone
Prostate CA- peripheral zone
BPH diagnostics
UA to rule out infection (prostatitis)
PSA- usually less than 10ng/ml
Urine cytology should be performed to rule out carcinoma particularly when hematuria is present
BPH sx
Nocturia Urine frequency Urgency/dysuria Urge incontinence/retention Decreased force of stream Hesitancy Post-void dribbling
BPH treatment
Alpha1-adrenergic agonists (Minipress, Hytrin, Cardura)
Subtype alpha1a- adrenergic receptor targets (Flomax, Uroxatral)
5-alpha reductase inhibitors (Proscar, Avodart)
Erectile dysfunction dx tests
BG to rule out DM Lipid profile TSH Testosterone level CBC PSA
Organic causes of ED
Obesity (BMI >31), metabolic syndrome, smoking, lack of exercise, DM, hyper cholesterol, HTN, age >40
meds- HCTZ, antidepressants
ED treatments
Sildenafil (Viagra) 25-100mg on demand dosing Tadalafil (Cialis) 5mg QD or 10-20mg on demand Vardenafil hydrochloride (Levitra) 10-20 mg on demand
Vaginal bleeding in a post menopausal woman is a red flag for what disease?
Endometrial cancer
Polycystic ovary syndrome definition
Defined by the presence of anovulation, polycystic ovaries on US, and clinical or biochemical hyper-androgenism
*genetic factors and insulin resistance play a role in the pathogenesis of PCOS
Pathophysiology of PCOS
The result of a defect in the hypothalamic pituitary-ovarian circuit.
PCOS diagnostic criteria
Any 2/3 confirmed:
- Oligomenorrhea or amenorrhea
- Hyperandrogenism (hirsutism, acne, alopecia or
- Hyperandrogenemia (high levels of testosterone)
- Polysystic ovaries on US
Long term health risks of PCOS
T2DM, CAD, Metabolic syndrome/insulin resistance, 2.7 fold increased risk of endometrial CA, mood disorders (anxiety/depression)
Management of PCOS
Weight reduction, lipid lowering meds (statins, nicotinic acid), insulin sensitizers (metformin, TZD’s), oral contraception and anti-androgens
Genital herpes clinical findings/tx
Painful, ulcerated lesions, marked lymphadenopathy with initial lesion. Grouped vesicles on erythematous base.
Tx-acyclovir (Zovirax), vancyclovir, famciclovir
Chlamydia trachomatis clinical findings/tx
Occasional mucopurulent discharge
Tx- Azithromycin 1g PO one time dose
Gonococcal inf clinical findings/tx
Occasional purulent discharge
Tx- Ceftriaxone 250mg IM one time dose, plus Azithromycin 1g (co-treat for chlamydia)
Trichomoniasis clinical findings/tx
Yellow-green vaginal discharge, occasionally frothy, cervical petechial hemorrhages
Tx- oral metronidazole 2g as one time dose
Alt option metronidazole 500mg po BID x7 days
Syphillis clinical findings and treatment
Primary- painless genital lesion/anal ulcer.
Secondary- non-pruritic rash on palms and soles, mucus membranes
Latent- neurosyphillis, dementia, ataxia
Tx- Injectable PCN, doxycycline in pts with beta lactam allergy
Genital warts (condyloma) clinical findings/tx
Verruca form lesions can be subclinical or unrecognized
Tx- prevention with immunization.
imiquimod (Aldara), surgical removal, cryotherapy
