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
What are the absolute contraindications to hormonal contraceptives?
Migraines w/ aura, CAD/CVA, undiagnosed genital bleeding, pregnancy’s, liver disease, estrogen-dependent tumor, thrombus, smoker >35 years old
Patient calls because they missed 1 dose of oral contraceptive, what should they be advised?
Take 2 pills now, continue taking remainder of the pack
If patient misses 2 or more consecutively, what should they be advised?
Take most recent pill missed (may mean to take 2), discard missed, and finish pack. Use alternative protection methods
What contraceptive that contains only progestin? When is it beneficial and when is it not?
Depoprovera or “mini-pill”
Avoid
-in those who wish to be pregnant soon after cessation (can take 12 months)
-anorexia/bulemia, high risk of osteoporosis
Beneficial
-ok with lactation
-lower cardiovascular risk
What are two contraindications to IUD use?
Active pelvic infection
History of ectopic pregnancy
Which oral contraceptives are indicated in treatment of acne?
Design, Ortho-TriCyclen, Yaz/Yasmin
How long does the Mirena (progesterone IUD) and Copper IUD last?
5 years for mirena
10 years for copper IUD
What is the safest contraceptive for woman with risky health conditions such as smokers, diabetics, those with cardiac or liver disorders?
Copper wire IUD
What is the recommendation for breast cancer screening?
Every 2 years for woman between 50-74 years
What diagnostic tests findings support the diagnoses PCOS?
Transvaginal US- multiple small follicles (ring of pearls)
Elevated Labs- serum testosterone, DHEA, androstenedione
Elevated FBS and 2-hour oral glucose challenge
What is the recommended treatment regime for PCOS
First line- oral contraceptives (medroxyprogesterone (Provera) for those who do not want contraceptive)
Aldactone for hirsutism
Metformin
Weight loss
The normal age for osteoporosis screening is 65, but what conditions would warrant earlier screening?
Drugs: Chronic steroids and PPIs
Gastric absorption: Gastric bypass, celiac disease, hyperthyroidism, RA, anorexia/bulemia
What is the recommended dose for calcium supplementation to prevent or treat osteoporosis?
1200mg a day with Vitamin D 800 IU
Excessive vaginal discharge, itching with a strawberry appearing cervix is suspicious for what disorder and what is the treatment?
Trichomonial vaginitis- metronidazole 2GM x 1 or 500mg bid x7 days
Fishy-like odor, profuse white milky vaginal discharge, presence of clue cells without vaginal itching is suspicious for this non-STI disorder and what is the treatment?
Bacterial vaginosis- metronidazole 500mg bid x 7 days
OR metronidazole gel q hs x 5 days
Thick curd-like white vaginal discharge with excessive itching is what condition and how is it treated?
Candidiasis Vaginitis- Diflucan 150mg x 1 (MRI x 1)
OR topicals: miconazole (monostat) OTC or clotrimazole (gyne-lotrimin) x 7days
What is the standard treatment for atrophic vaginitis?
Lubrants, topical estrogen for more severe cases)
What is a common post-menopausal breast finding?
They will feel softer and have less volume
Bisphosphonates are the fist line treatment for osteoporosis. What is a common risk and some contraindications?
Esophageal and gastric inflammation.
CI: PUD disorders, esophageal motility disorders, hx GI bleeding, inability to sit up right, CKD
What t score indicates osteoporosis and osteopenia?
osteoporosis t >-2.5
osteopenia t -1.5 to -2.4
T/F Turner syndrome is a primary cause of amenorrhea?
True
A sudden and abrupt oneset of painful vaginal bleeding in a woman in her 2nd or 3rd trimester is likely?
Abruptio placentae
Placenta Previa presents as?
During late 2nd and 3rd trimester with sudden oneself painless vaginal bleeding, usually bright red.
T/F abruptio placentae is a surgical emergency?
True
A gravid patient in later 2nd to 3rd trimester that reports RUQ pain, pitting edema, visual disturbances, headache, nausea who is found to be hypertensive with proteinuria has what disorder?
Severe pre-eclampsia
What is the drug of choice to prevent eclampsia?
Magnesium sulfate
A patient with pre-eclampsia symptoms is found to have elevated liver enzymes and thrombocytopenia has what condition and what is the associated emergency?
HELLP syndrome- risk for hepatic rupture
What labs normally elevate in pregnancy?
ALP, lipids, T3, WBC, platelets, sed relate and GFR
What is the most important nutritional supplement to prevent neural tube defects?
Folic acid
What is the normal increase rate of HCG in first 12 weeks?
It doubles every 48 hours
During prenatal screening, the AFP is elevated, what test should be ordered?
Triple (AFP, Beta HCG, Estroil serum levels) or quad screen (adds inhibin A)
What bacteria increases risk of pre-term labor and is screened for via culture in early pregnancy?
Group B beta-hemolytic strep
What do the drug pregnancy categories mean?
Category A- animal and human show no risk
Category B- animal show no risk, no human data
Category C- Adverse effects in animal and human
Category D- Evidence of fetal risk. Benefits must outweigh risk.
Category X- Proven fetal risk outweighs benefit
What are some Category A drugs?
Prenatal vitamins
Insulin
Levothyroxine
Folic acid and b6
What are some Category B drugs?
Antacids
Colace
Acetaminophen
Abx: PCN, Cephalosporins, erythromycin, azythromycin, nitrofurantoin (up to 3rd trimester)
Antihypertensives: methylevodopa (aldomet), labetolol (normodyne), nifedipine
What are some Category C drugs?
Sulfa, bactrim, pseudoephedrine, and clarithromycin
What are some Category D drugs?
ACEI/ARBs, Fluoroquinolones, tetracyclines, NSAIDS, and Sulfa drugs
What are some Category X drugs?
Accutane (trentinoins) and retinoid topicals, methotrexate, mioprostol, vista/tamoxifen, hormonal drugs (estrogen, testosterones, finasteride)
T/F SSRIs pose significant risk in first trimester?
True
T/F woman with normal pre-pregnancy BMI should gain 25-35 lbs?
True
How much weight should pre-pregnant obese patients gain?
11-20 lbs
Goodell’s, Chadwick’s, and Hegar’s signs are all signs of pregnancy. What do they each mean?
Goodell’s- cervical softening
Chadwick’s- bluish discoloration to cervix and vagina
Hegar’s- softening of the uterine isthmus
What are the 3 positive signs for pregnancy?
Palpation of fetus by provider
Ultrasound visualization of fetus
Fetal heart tones (10-12 weeks via Doppler)
What are the Probable Signs of pregnancy
Goodell’s, Chadwick’s, and Hegar’s signs
Enlarge uterus
Ballottement
Urine/blood HCG tests
When does the fundal height usually reach the umbilicus?
20 weeks
At 16 weeks, the fundus can usually be found where?
Between symphysis pubis and the umbillicus
Fundal height just above symphysis pubis is typically what week’s gestation?
12 weeks
T/F S4 is common during pregnancy?
False- S3 is
T/F Preload increases and afterload decreases during pregnancy?
True
How do you calculate estimated date of delivery (EDD) using Naegle’s rules?
Only applicable is menses were regular:
1: LMP+ 9months+ 7days
2: LMP- 3months + 7days
GTPAL stands for and is reported as?
Gravida: total number of pregnancies
Term: total number term births after 37 weeks
Preterm: number of deliveries between 20-37 weeks
Abortions: number of relievers before 20 weeks
Living: number of living children
What is the dose of Rhogam and when is it given?
300mg IM, at 28 weeks and within 72 hours of delivery. If miscarriage or spontaneous/induced abortion- give within 72 hours
The one-step 75mg oral glucose test at 24-28 weeks is preferred. Glucose is checked fasting, 1 hour, and 2 hours. What would determine abnormal result?
One of the following:
Fasting >/= 92
1 hour >/= 180
2 hour >/= 153
What is the first line treatment for GDM (gestational diabetes)
Lifestyle diet and exercise
Insulin if needed
What are the risk factors for GDM (gestational diabetes)
Obesity, multigravid, >35 years old, macroscopic infant (>9lbs), and ethnicity (brown skin races)
T/F always treat an asymptomatic bacteremia in a pregnant woman?
True
T/F a basic UTI in a pregnant woman is considered uncomplicated?
False- all UTIs in pregnancy are considered complicated
What is the classic triad of findings in preeclampsia?
SBP >/= 140, DBP >/= 90
Proteinuria
Rapid weight gain 2-5lbs/week
T/F woman should be encouraged to continue breast feeding with mastitis on the affected side?
True
What is the DOC for MRSA and non-MRSA suspected mastitis?
MRSA- bactrim or clindamycin
Non-MRSA Keflex
What is the DOC for treating chlamydia in pregnancy?
Azithromycin
What is the treatment for Chlamydia?
Azythromycin 1mg PO x1
OR
Doxycycline 100mg PO BD x 7 days
What is the recommended treatment for gonorrhea?
Rocephin 500mg IM x 1
T/F always co-treat gonorrhea and chlamydia?
True
What is the test to screen for syphilis?
RPR and VDRL- if positive, confirm with FTA-ABS
Fitzs-Hugh-Curtis Syndome (Perihepatitis) is seen with what disorder and how is it treated?
PID complication where chlamydia/gonorrheal infection that spreads to the liver.
Rocephin 500mg IM +Doxycycline 100mg x14 days + Metrondiazole 500mg x 14 days.
This condition presents as acute rheumatoid-like arthritis and conjunctivitis in patients brought on by certain bacterial infections (salmonella, chlamydia, shigella, campylobacter and Yesenia)?
Reiter’s Syndrome (reactive arthritis)
What is viral load?
Number of RNA copies/1ml of plasma
What is the screening test for HIV?
HIV-1/HIV-2 antibodies with antigen reflex
In patient with HIV, CD4 count is 200 or less, what therapy should be initiated?
P. Jirovecci pneumonia prophylaxis with bactrim DS Q day (dapsone for sulfa allergies)
Patient presents with hairy leukoplakia of the tongue and recurrent oral candidiasis, what screening test should be ordered?
HIV-1 HIV-2 antibody with antigen reflex
What is the treatment of choice for condyloma?
-Podofilox 0.5% (CI in pregnancy) apply q 3 days, hold for 4 days- repeat cycle 4 times. It is an antimitotic drug
-Imiquimod 5% thin layer 3 times/week up to 16 weeks. Leave on 6-10 hours. Is an immune-modulating drug
-Vergne derived from green tea up to 3 times a day for 16 weeks
T/F HSV-2 causes most recurrent genital herpes lesions?
True
Which stains of HPV are oncogenes?
16 and 18
What are the treatment options for acute (first episode) HSV?
Acyclovir 400mg tid x 7-10 days
Valacyclovir tid x 7-10 days
Famcyclovir 1gm bid - 7-10days
T/F episodic and suppression therapies with acyclovir/famciclovir/valacyclovir are appropriate for recurrent HSV?
True
T/F The 4th generation p24 antigen HIV 1/2 combo tests can detect HIV sooner than other HIV tests?
True
Jarish-herxheimer reaction is a perihepatitis infection caused by what condition?
syphilis- treponema pallidum
When monitoring the patient’s response to antiviral drugs, this finding would indicate favorable response?
Increasing CD4
By 2 months old, the infant should do demonstrate the following milestones?
Follow object post midline
Coos vowels
Lift head 45 degrees
Smile in response to another
By 4 months old, the infant should do demonstrate the following milestones?
Spontaneous smile (social)
Babble
Bring hands to mouth
Swing at dangling toys
Holds head steady and unsupported
Rolls front to back
By 6 months old, the infant should do demonstrate the following milestones?
Palmar grasp of objects
Reaches for toys using palmar grasp
Brings objects to mouth
Starts to pass from one hand to another
Begins to sit up independently
Rolls in all directions
Says consonants (da da)
Curious and watches environment
By 9 months old, the infant should do demonstrate the following milestones?
Pincer grasp starts, can pick up food and items with thumb and forefinger
Waves bye bye
Claps hands
Pulls self to standing, crawls and cruises
Bears weight well
Plays pee-a-boo
Stranger anxiety
By 12 months old, the infant should demonstrate the following milestones?
Use snippy cup
Stand and usually walk independently
Move from furniture to furniture for support
Says 1-2 words (other than mama, dada)
uses exclamations such as uh-oh!
Knows their name
Growth rate will slow down
Follows simple instructions
By 15 and 18 months old, the infant should do demonstrate the following milestones?
15 months -feeds self, drinks from cup, walks long distances, 4-6 word vocabulary, follows gestured commands
18 months- turns pages of book, walk up steps, point to 4 body parts, vocabulary 10-20 words
Infant with delay in femoral pulse compared to brachial pulse is likely to have what disorder?
Coarction of the Aorta
A toddler is found to have weight loss, fever, subcutaneous nodules, and Horner’s syndrome, what condition should be suspected?
Neuroblastoma
How is Wilm’s Tumor and neuroblastoma differentiated on exam?
Wilms is generally smooth and rarely crosses the midline
Neuroblastoma is irregular and often crosses the midline
T/F it is normal speech of the 2 year old to included two word phrases mostly understood by the family?
True
A preschooler should have how many teeth?
16-2-
By late adolescence, how many teeth should they?
32- full set
Where is the PMI heard in an 8 year old?
5th ICS lateral to MCL, just like adults
Under 7 is between 3-4th ICS
In children with Tetralogy of Fallot, what defects are present?
VSD, overriding aorta, pulmonary stenosis and R. Ventricular hypertrophy
At what age is genu-Valgum considered normal?
After 3 years, generally have a varum presentation prior
