GU, STI, Sexual Health and Pregnancy Flashcards
What is the bacteria count on a symptomatic patient that confirms UTI diagnosis?
At least 100,000 organisms in asymptomatic pt and more thatn 100 org/ml with pyuria in symptomatic pt
UTIs are more common in sexually active woman? T/F
True
What is the leading cause of UTI in young men?
STI
What is the leading cause of UTI in older men?
Prostate issues
What is findings on urine dip are associated with UTI?
+ Nitrites & leukocytes
What is the first line therapy in female uncomplicated UTI?
Nitrofurantoin (macrobid) 100mg bid x 7d (5d)
Keflex
Bactrim DS bid X 3 days
What is the standard treatment for UTI in males?
Young men: Doxycycline 100mg bid x 7-10 days
Older men: cipro 500mg bid x 7-10 days
What are the common causative organisms for UTI in women?
E Coli #1
Klebsiella
Proteus
Staph/Strep (usually sexual activity)
B strep in pregnant females are always treated
What findings are present in acute pyelonephritis?
Systemic findings: Fever, tachycardia, N/V and general illness
Flank pain & CTA tenderness
When should a pt w/ pyelonephritis be referred to the ED & admitted?
Pregnancy, severe N/V and dehydration, or fever >101
Also- ill elderly
What is the recommended treatment for pyelonephritis?
Rocephin 500-1000mg IM then:
-Cipro 500mg bid 5-7 days
-levofloxacin 750mg qd x 5-7d
-Bactrim DS 7-10day (only if known pathogen)
-Augmentin bid 10-14 days
-cefdinir 300mg bid 10-14 days
How often should an OP pyelonephritis return for re-eval?
In 24-48 hrs then in 3-5 days for repeat UA if improving
What 2 tests are standard to elevalute prostate for CA/BPH?
DRE & PSA
What is the normal PSA?
<4
What is the first line treatment for BPH and how does it work?
Alpha 1 receptor agonist relax the smooth muscle of the bladder neck and prostate/urethra: (terazosin, doxazosin, tamulosin)
What drugs reduce the size of the prostate gland?
5alpha reductase inhibitors: Finasteride & dutasteride blocks DHT
Can 5 alpha reductase inhibitors and alpha-1 blockers be combined?
Yes
What other type of drugs can be used to treat sx of BPH?
Anticholinergics: Oxybutynin and Tolterodine help with urinary sx (frequency, nocturia and urgency)
If a patient is on finasteride, would an elevated PSA be considered normal?
No
+ Phren sign is commonly found in_____?
Epididymitis (pain is relieved w/ testicular elevation)
What would be the recommended treatment for a man under the age of 35 for epidymitis?
Rocephin 500mg IM x1
And
Axithromycin1g PO once
OR Doxycycline 100mg bid x 10 days
What would be the recommended treatment for a man over the age of 35 with low risk for STI for epidymitis?
Cipro 500mg bid x10d
OR
Levofloxacin 500mg qd x10d
Testicilar torsion usually lacks which two signs
Absent cremasteric sign
-phren sign
What are the common presenting symptoms with acute prostatitis?
decreased urine flow & dysuria
Lower back/rectal pain
Pain with ejaculation or defecations
Increased pain with sitting
Fever/chills/malaise
What is the treatment for prostatitis unlikely to be related to STI?
Cipro 500mg bid x 3-4 weeks
Doxycycline 100mg bid x 3-4 weeks
Bactrim DS bid x 3-4 weeks
Levaquin 500mg q day x 3-4 weeks
If prostatitis is possibly related to Gonorrhea or Chlamydia, what is the treatment of choice?
Rocephin 1gm x 1
Doxycycline 100mg bid x7days
What can be used to treat the discomfort of prostatitis?
NSAIDS & stool softners
Testicular torsion generally presents as?
Young atheletic male sudden onset severe unilateral testicular pain without cremasteric sign and - phren sign.
What are two differentiators between epidymitis and torsion?
epidymitis with have + prehns sign and + cremasteric sign
Torsion will be negative to both
At what age should both testicles be decended?
1 year
A varicele is_____?
A dilated spermatic vein, resembles a “bag of worms”
Can be painless or painful
Reproduced when standing and resolves w/ sitting
Tx w/ NSAIDS and referral
Functional incontinence is when?
There is a physiologicial or cognitive disability
Sudden sensation of urge, difficulty in making it to the bathroom in time, and leakage is usually found in this type of incontinence?
Urge
Overflow incontinence causes _____?
Dribbing from over-distended bladder due to chronic distention & poor emptying of urine
Overactive and unstable detrusor muscle causes what type of incontinence?
Urge incontinence
Stress incontinence is generally treated with?
Kegel exercises, bladder training, and timed voiding. Estrogen cream twice weekly for post menopausal women.
Urge incontinene is usually treated with?
Toviaz, Vesicare, Ditropan and oxybutynin to treat over-active bladder
Overflow incontinence is commonly seen with _____ conditions?
Neurological disorders (spinal cord, myesthenia gravis, dementia, parkinsons)
Outlet obstruction (prostate, mass, cystocele)
Fecal impaction
Medications (sedatives/opiates)
An infection on the glans penis that is more common in uncircumcised men that presents with redness, pain, tenderness and pruritis with discharge is what condition, what is the causative agent, and how is it treated?
Balanitis, usually candidal- OTC azole creams such as clotrimazole 1% or miconazole 2% bid x 7-14 days
T/F cryptorchidism increases risk of testicular cancer?
True
Phimosis is ____?
Inability to retract foreskin
Paraphymosis is?
Inability to return foreskin to natural position
What genetic susceptibility test also indicates a higher risk for ovarian cancer?
BRCA1 & BRCA2 genes
55 year old female presents unilateral with change in breast color/texture similar to orange peel, what is this called and what should be ordered?
Peau d’orange- concerning for breast cancer- diagnostic mammogram should be obtained with ultrasound if negative. Plan for referral to surgeon for biopsy
70 year old female presents with unilateral rash around the nipple that is red, scaly, pruritic or painful that is spreading around the areola, what does this represent?
Paget’s disease of the breast
52 year old woman presents with sudden onset breast pain, redness, swelling, and warmth that is unilateral and growing rapidly. What should be suspected and ruled out urgently?
Inflammatory breast disease
A 35 year old woman presents with complaint of new onset fatigue, vague abdominal and lower back pain, dyspareunia and changes in bowel habit. What condition should be ruled in or out?
Ovarian cancer
A 26 year old female presents with severe RLQ pain started out as dull but now is more sharp and intense. What emergency condition must be ruled in or out?
ectopic pregnancy
What Tanner stage begins with newly formed breast buds?
Stage II
What performing a Pap smear, the cervix is found to have a large ectropion, what is an important part of the technique with this presentation?
Sample the surfaces f the transformation zone (TZ) as this is where abnormal cells are more likely to develop.
Uterine leiomyoma is also know as?
Uterine fibroids
This condition causes woman to have excessive ovarian cysts, increased adiposity, hirituism, acne, oligomenorrhea and insulin resistance?
PCOS
Which hormone is predominant during the first 2 weeks of cycle (follicular phase)?
Estrogen- stimulates development and growth of the endometrium
Which hormone is predominant during the ovulatory phase (day 14) or midcycle?
LH- luteinizing hormone, it induces ovulation and maturation
During literal phase (day 14-28), what hormone is predominant?
Progesterone- helps to stabilize the endometrial lining
What is the recommendations for PAP smear screenings?
First at 21, then every 3 years between ages of 21-65. After 30, add HPV q 5 years
Pap results with ASC-US (atypical squamous cells of undetermined significance), what is the recommendation?
Repeat pap in 12 months, if over 25 add HPV test.
Refer for colonoscopy if >30 with +HPV and PAP
Pap results with ASC-H (atypical squamous cells of high-grade intraepithelial lesion), what is the recommendation?
Refer for colposcopy
Pap results with LIS (low-grade squamous intraepithelial lesions), what is the recommendation?
Under 25- repeat PAP in 12 months
25-29 refer for colposcopy
Over 30 either repeat in 12 months or refer for colposcopy
Pap results with HIS (high-grade squamous intraepithelial lesions), what is the recommendation?
Under 25- refer for colposcopy
Over 25- colposcopy or excision by LEEP
Examples of oral contraceptives that combine estrogen and progesterone?
Losestrin, Ortho-Novum, Ortho Tri-Cyclen, Yaz (drospirenone is a spironolactone analogue), and Seasonale (84 days of estrogen with 7 progesterone= 4 periods/year)
Which oral contraceptive is recommended for woman with PCOS and why?
Yaz- aldosterone analogue