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primary care midterm > GU-Peds > Flashcards

GU-Peds Flashcards

1
Q

dysuria

A
  • Painful urination, in the urethra
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2
Q

dysuria causes

A

o Stones
o Cystitis (bladder inflammation)
o Medications
o Kidney stones
o Prostatitis
o Vaginitis
o Soaps, perfumes and personal care products

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3
Q

Hematuria

A
  • Gross hematuria produces pink, red or cola-colored urine d/t presence of red blood cells.
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4
Q

hematuria causes

A

o UTI
o Kidney infections/Pyelonephritis
o Bladder/kidney stone
o Enlarged prostate
o Cancer
o Strenuous exercise
o Inherited disorders–Sickle cell anemia

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5
Q

hematuria risk factors

A

o Age (older men d/t prostatitis)
o Kidney inflammation
o Family hx
o Medications
o Strenuous exercise

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6
Q

hematuria diagnostics

A

o Physical exam
o Urinalysis/urine culture
o Imaging
o CT scan/MRI
o Cystoscopy

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7
Q

tx of hematuria

A

o Dependent upon the cause of hematuria

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8
Q

kidneys and the tubular system mature throughout childhood reaching full maturity during _______

A

adolescence

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9
Q

bladder capacity ____ with age

A

increases

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10
Q

UTIs: etiology

A

o Anatomic abnormalities
o Neurogenic bladder-incomplete emptying of the bladder
o In the older child: infrequent voiding and incomplete emptying of bladder or constipation
o Teenager: sexual intercourse due to friction/trauma

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11
Q

UTIs- female

A

o Most common in females
o Short Urethra
o Improper wiping
o Nylon underwear/thongs

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12
Q

UTIs- males

A

o Higher in uncircumcised males
o Instruct parents to gently retract foreskin for cleansing
o Do not force the foreskin
o Do not leave foreskin retracted of it may act as a tourniquet and obstruct the head of the penis resulting in emergency circumcision

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13
Q

UTIs s/s

A

o Urinary frequency
o Urinary hesitancy
o Dysuria
o Cloudy, blood tinged
o Musty smell/foul odor to urine
o Fever
o Poor feeding/failure to grow
o Neonates may only exhibit fever and poor feeding/failure to grow

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14
Q

diagnostics UTIs

A

o Urinalysis
o Catheterized specimen vs non-catheterized specimen
o Urine culture

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15
Q

tx of UTIs

A
  • 1st line in children w/out GU abnormalities: Cephalosporin
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16
Q

pt education UTIs

A

o Rinse well after the bath
o Good hygiene, wiping front to back
o Changing wet diapers/underwear ASAP
o Working on toileting schedule; holding urine can cause UTIs
o Cotton underwear recommended

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17
Q

pyelonephritis

A

kidney infection

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18
Q

s/s of pyelonephritis

A

o Fever
o Chills
o Flank pain; unilateral middle back pain
o Abdominal pain
o Suprapubic tenderness
o Urinary urgency/frequency may/may not be present
o Fever
o Nausea and vomiting
o Foul smelling urine

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19
Q

tx of pylenophritis

A

o Send to the ED
o Requires IV antibiotics/close monitoring

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20
Q

urethritis

A
  • Urethral irritation d/t chemicals or manipulation
  • Most common in females
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21
Q

urethritis causes

A
  • bubble baths
  • scented wipes
  • nylon underwear
  • Self-manipulation
  • Child Abuse
22
Q

tx of urethritis

A

o If caused by a new product, stop the product
o Avoid touching the area
o Avoid long bubble baths
o Can do a baking soda bath:
* 1 cup of baking soda per ½ tub of water
* Soak in this for 10-15 minutes
* This will help neutralize irritants
* Rinse well after

23
Q

ovarion torsion

A
  • Ovarian (adnexal torsion) occurs when the ovary/fallopian tube becomes twisted around the tissue that supports it.
  • Most commonly occurs during reproductive years, although can occur outside of this window as well
  • Extremely painful
  • Cuts off blood supply to the area
24
Q

risk factors for ovarian torsion

A

o PCOS
o Have a long ovarian ligament
o Hx of tubal ligation
o Pregnancy
o Ovarian cyst history
o You are undergoing hormonal treatments, usually for infertility, which stimulates the ovary

25
Q

ovarian torsion: s/s

A

Sudden onset/without warning of:
* severe, sudden pain in the lower abdomen (there is always pain associated with torsion); if no pain, do not worry about torsion
* Cramping
* Nausea
* Vomiting
* In some cases, pain, cramping, and tenderness in the lower abdomen may come and go for several weeks. This can occur if the ovary is attempting to twist back into the correct position.

26
Q

ovarian torsion tx

A

Medical Emergency:
* Emergency Surgery to correct it; only viable for 6-8 hours if strangulated
* Recommend NPO on the way to the ED

27
Q

testicular torsion

A
  • Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.
28
Q

risk factors of testicular torsion

A

o Most common between the ages of 12-18
o Previous torsion
o Family history of torsion

29
Q

causes of testicualr torsion

A
  • Can be precipitated by an “event”: kick in the testicles, getting a ball kicked in the groin, spinning, rough sex etc…
30
Q

s/s testicular torsion

A

o Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
o Swelling of the scrotum
o Abdominal pain
o Nausea and vomiting
o A testicle that’s positioned higher than normal or at an unusual angle
o Frequent urination
o Fever

31
Q

testing for testicular torsion

A

Prehn’s sign:
* If lifting of the testicle exacerbates/worsens the pain, high suspicion of torsion

32
Q

GU adhesions

A
  • Labial adhesions in females
  • Penile adhesions in males
  • Both considered physiologic prior to puberty and most resolve spontaneously with hormone changes
33
Q

GU adhesions tx

A
  • Topical application of Premarin cream for females
  • Topical steroid (betamethasone 0.1%) in males
34
Q

phimosis

A
  • When foreskin can’t be pulled down (retracted) from the tip of the penis
  • Common in young uncircumcised boys
35
Q

phimosis: s/s

A

o Bulging of the foreskin during urination
o Not able to fully retract the foreskin by 3 years old; occasionally it can take longer

36
Q

phimosis: tx

A

o Topical steroid (betamethasone 0.1%) in males
o Circumcision

37
Q

paraphimosis

A
  • When foreskin is retracted but can’t move back up
  • Can prevent blood flow in penis
38
Q

paraphimosis: s/s

A

o Swelling of the tip of the penis when the foreskin is pulled back
o Pain
o Not able to pull the foreskin back over the tip of the penis
o Tip of the pneis that is dark red/blue in color

39
Q

paraphimosis: tx

A

o Lubricating the foreskin and the tip of the penis, then gently squeezing teh tip of the penis while pulling the foreskin forward
o Making a small incision in the foreskin
o Circumcision

40
Q

balanitis

A
  • Pain/inflammation of the glans of the penis
  • Most often in uncircumcised males
  • Typically caused by yeast, however can also be bacterial/viral
  • Not contagious
41
Q

balanitis risk factors

A

o Poor hygiene
o Diabetic
o Obese
o Sensitivity to chemical irritants

42
Q

balanitis s/s

A

o pain/inflammation of the glans of the penis
o Redness/red patches on the penis
o Itching under the foreskin
o Swelling
o Areas of shiny/white skin on the penis
o White discharge (smegma) under the foreskin
o Foul smell
o Painful urination
o Sores/lesions on the glans

43
Q

balanitis diagnosis

A

o Physical exam
o You can swab/culture
o Urine sample to rule out UTI/STI

44
Q

balanitits tx

A

o Antifungal creams
* Clotrimazole
o Antibiotics (if caused by STI)
o Discuss improving hygiene
o Diabetic Management
o Circumcision: if recurrent, this will be the recommendation

45
Q

vulvovaginitis

A

vulva becomes very irritated and inflamed, which becomes swollen and red

46
Q

vulvovaginitis s/s

A

o Dysuria, usually transient and without fever or other signs of UTI
o Itching
o Burning
o Perceived excessive “touching down there”
o Discharge
o Redness in vulva

47
Q

vulvovaginitis common findings

A

o Erythema, rash or fissure
o Whitish, cheesy discharge
o Thin, milky discharge
o Yellowish, foul-smelling discharge
o More rare: trauma or foreign body

48
Q

common causes of vulvovaginitis

A
  • Poor hygiene
  • Irritation from moisture
  • Tight fitting clothes
  • Obesity
  • Soaps and detergents
  • Toilet paper or masturbation
  • Pinworms
  • Foreign body (toilet paper or bath toys)
  • Physiologic leukorrhea (common just prior to menarche)
49
Q

less common causes

A

Bacterial infection
* Strep: may see serous drainage or greenish mucoid discharge
* Yeast
* more likely in adolescence or post-menarchal patients
* common in diabetic teens poorly managed

50
Q

tx of vulvovaginitis

A

o Check UA/urine culture if suspicious for UTI
o Review healthy potty and hygiene habits
o Avoid irritants
o Vaginal culture and empiric treatment for suspected bacterial infection
o Culture and/or treat for yeast
* If recent antibiotic or steroid use
* If diabetic patient
* If postmenarchal

primary care midterm (12 decks)

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