Module 2 - GU (all) Flashcards
- Cystitis Symptoms
(lower UTI)
- frequency/urgency
- nocturia
- dysuria
- voiding in small amounts
- hematuria
- suprapubic tenderness
- Cystitis Diagnostics and follow up
- maybe pregnancy test
- UA
- STI: including chlamydia and gonorrhea
(recommend any sexually active women under 24yo)
sx must be completely resolved by end of treatment
- First Line Abx for Cystitis
- nitrofurantoin (macrobid)
100mg BID x 5 days (C) - TMP/SMX (bactrim)
800/160mg BID x 3 days (B) - fosfomycin
3000mg daily x once (B)
THEN
beta lactam (amoxicillin-clavunate) or cephalosporin (sephs or cefs)
IF CANT beta then fluorquinolones (floxacins)
- Hernia’s General Info
- hernia is a weakness or hole in the abdominal structure which allows protrusion of a viscous structure in the cavity in which it is normally contained
- usually harmless but ALL have risk of losing blood flow/becoming strangulated
- if blood supply is cut off at abdominal wall it is a MEDICAL and SURGICAL emergency
- anything that contributes pressure to abdominal wall will worsen it
> obesity, heavy lifting, coughing/straining, BM,
urinating, fluid in abd cavity, hereditary
- Strangulated Hernia
- irreducible hernia where the entrapped intestine has blood supply cut off
- PAIN IS ALWAYS PRESENT AND IS A SURGICAL EMEGENCY
- Indirect Hernia
- sac herniates through the INTERAL INGUINAL RING
- scrotal pain common
- pain with straining
- soft swelling with increased intrabdominal pressure
- may protrude into inguinal canal or scrotum
- will tap against tip of finger upon assessment
- Direct Hernia
- goes directly through abdominal wall and NOT through inguinal canal !!!!!!!!
- if small hernia (during inguinal exam), you will feel it tap on the BACK of your finger
Femoral Hernia
- least common
- usually women on right side
Diagnostics
- physical exam and history
- rarely need US or CT
Orchitis
can be viral or bacterial
- bilateral scrotal pain
- scrotal enlargement
- fever
- n/v
- indurated
- tender
UA dipstick: +blood, +protein
potential causes:
viral: mumps
bacterial: STI (chlamydia or gonorrhea)
- Hydrocele
- fluid collection in scrotal space
- usually between layers tunica vaginalis
- Hydrocele S/S
- scrotal enlargement
- scrotal heaviness
- discomfort, radiation to inguinal area
- back pain
- most are smooth and nontender
- important to still palpate tests bc sometimes hydrocele presents with testicular ca/tumor
- Testicular Tumor
- seminomas (average age is 36 years)
- non seminomas germ cell tumor (average age is 30 yrs)
- up to 95% are GCT’s
- age
- risk factors
- cryptorchidism (undescended testes) maaaajor risk
factor
- even with early repair - previous testicular cancer (contralateral)
- infertility
- cryptorchidism (undescended testes) maaaajor risk
(other risk factors: down syndrome, Klinefelter, tobacco use, whites)
- Diagnostics in Testicular Tumor
ULTRASOUND
- CT for staging (cap)
- labs
- serum tumor marker alpha fetoprotein
- HCG and LDH (critical for diagnosing)
refer, surgery (orchiectomy), chemo, radiation
- Torsion
sudden onset scrotal pain
n/v
fever
tender firm testes
absent cremasteric sign ( no ball lifting - NEG sign)
negative prehns sign ( no pain relief )
ultrasound IMMEDIATELY shows spermatic cord twist
** 80% testicular salvage if diagnosis of torsion occurs within 12 hours
- prehn’s sign
(torsion)
no pain relief = negative
pain relief = positive
result is inferior to an ultrasound results
- cremasteric sign
stroke inner aspect of thigh with relflex hammer or tongue blade
- elevation of ipsilateral (same side)
- positive means it pulls up
- negative means it does not
varicocele
develop slowly
dull constant pulling sensation on one side
worms
left side is typical
right side is atypical
epididymitis
chlamydia and gonorrhea
NAAT (urine)
scrotal elevation HELPS
Acute prostatitis * s/s and treatment and diagnostic
s/s:
irritative urinary symptoms
diagnostic:
- UA WITH CULTURE
treatment:
high risk of STI
- ceftriaxone 250mg IM x 1 and doxy 100mg BID x 10
low risk of STI
- bactrim BID
- 500mg LEVOFLOXACIN DAILY
- 500mg CIPROFLOXACIN BID
TREAT FOR 4-6 WEEKS
RECHECK AFTER 2 WEEKS
if chronic bacterial (poss tx for 4-12 weeks) and use levo or cipro
- Prostate Ca screening
two tests ( secondary prevention )
- DRE and PSA
USPSTF recs against PSA or DRE screening unless their are symptoms
- DRE and PSA = most sensitive and specific screening method for detection of prostate ca
- prostate ca diagnostics
Refer to Urologist
TRUS and Biopsy rec for the following:
- less than 60 and PSA > 2.6 or abnormal DRE
- more than 60 and PSA > 4
- male sexual dysfunction mgmt
- psych
- lifestyle changes and pharm therapy
- anxiety reduction
- testosterone replacement
- PDE5 inhibitors
- 2nd line therapies
- penile implants
tadalafil has longest duration
- pyelonephritis treatment
CIPROFLOXACIN 500mg BID x 7
cipro ER 1000mg daily x 7
ofloxacin 400mg BID x 7
levofloxacin 750mg daily x 5 days
bactrim 800/160mg BID x 14
- dipstick UA
- pyuria, blood yeast
- leuks: positive means WBCs in urine
- nitrates: positive means bacteria in urine
- urea increased if proteus organism
- hematuria common in +uti
sensitivity 75-90
specificity 94-98
70 yr old with issues with frequency, have to go all of the time, dribbles. PSA of 6. next steps
transrectal ultrasound
chlamydia and gonorrhea possible cause of the following
prostatitis
epididymitis
orchitis
44 yr old main with issues getting urine started, difficulty ending stream, wakes with urge to go. urge incontinence. what to order
UA AND CULTURE
male presents with painless ulcer on his genitals. ulcer is indurated margin. what abx?
doxy
cef
azithro
cipro
male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find
syph
herpes zos
gonorrhea NO
chlamydia
male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find
syph
herpes zos
gonorrhea NO
chlamydia
irritative urinary symptoms may be found with which of the following conditions?
prostatitis and epididymitis
of all of these treatments for herpes, which is the most useful for ASYMPTOMATIC viral shedding of herpes simlex type 2
valacyclovir
diagnosis of ____ elevation of the scrotum improves the pain
epididymitis
male presents with painless ulcer on his genitals. ulcer is indurated margin. what abx?
doxy
cef
azithro
cipro
NONE OF THE ABOVE
male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find
syph yes?
herpes zos
gonorrhea NO
chlamydia
