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ADULT EXAM 1 > Module 2 - GU (all) > Flashcards

Module 2 - GU (all) Flashcards

1
Q
  • Cystitis Symptoms
A

(lower UTI)

  • frequency/urgency
  • nocturia
  • dysuria
  • voiding in small amounts
  • hematuria
  • suprapubic tenderness
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2
Q
  • Cystitis Diagnostics and follow up
A
  • 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

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3
Q
  • First Line Abx for Cystitis
A
  1. nitrofurantoin (macrobid)
    100mg BID x 5 days (C)
  2. TMP/SMX (bactrim)
    800/160mg BID x 3 days (B)
  3. fosfomycin
    3000mg daily x once (B)

THEN
beta lactam (amoxicillin-clavunate) or cephalosporin (sephs or cefs)
IF CANT beta then fluorquinolones (floxacins)

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4
Q
  • Hernia’s General Info
A
  • 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
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5
Q
  • Strangulated Hernia
A
  • irreducible hernia where the entrapped intestine has blood supply cut off
  • PAIN IS ALWAYS PRESENT AND IS A SURGICAL EMEGENCY
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6
Q
  • Indirect Hernia
A
  • 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
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7
Q
  • Direct Hernia
A
  • 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
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8
Q

Femoral Hernia

A
  • least common
  • usually women on right side
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9
Q

Diagnostics

A
  • physical exam and history
  • rarely need US or CT
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10
Q

Orchitis

A

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)

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11
Q
  • Hydrocele
A
  • fluid collection in scrotal space
  • usually between layers tunica vaginalis
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12
Q
  • Hydrocele S/S
A
  • 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
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13
Q
  • Testicular Tumor
A
  • 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

(other risk factors: down syndrome, Klinefelter, tobacco use, whites)

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14
Q
  • Diagnostics in Testicular Tumor
A

ULTRASOUND
- CT for staging (cap)
- labs
- serum tumor marker alpha fetoprotein
- HCG and LDH (critical for diagnosing)
refer, surgery (orchiectomy), chemo, radiation

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15
Q
  • Torsion
A

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

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16
Q
  • prehn’s sign
A

(torsion)
no pain relief = negative
pain relief = positive

result is inferior to an ultrasound results

17
Q
  • cremasteric sign
A

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
18
Q

varicocele

A

develop slowly
dull constant pulling sensation on one side
worms
left side is typical
right side is atypical

19
Q

epididymitis

A

chlamydia and gonorrhea
NAAT (urine)
scrotal elevation HELPS

20
Q

Acute prostatitis * s/s and treatment and diagnostic

A

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

21
Q
  • Prostate Ca screening
A

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
22
Q
  • prostate ca diagnostics
A

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

23
Q
  • male sexual dysfunction mgmt
A
  • psych
  • lifestyle changes and pharm therapy
  • anxiety reduction
  • testosterone replacement
  • PDE5 inhibitors
  • 2nd line therapies
  • penile implants

tadalafil has longest duration

24
Q
  • pyelonephritis treatment
A

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

25
Q
  • dipstick UA
A
  • 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
26
Q

70 yr old with issues with frequency, have to go all of the time, dribbles. PSA of 6. next steps

A

transrectal ultrasound

27
Q

chlamydia and gonorrhea possible cause of the following

A

prostatitis
epididymitis
orchitis

28
Q

44 yr old main with issues getting urine started, difficulty ending stream, wakes with urge to go. urge incontinence. what to order

A

UA AND CULTURE

29
Q

male presents with painless ulcer on his genitals. ulcer is indurated margin. what abx?

A

doxy
cef
azithro
cipro

30
Q

male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find

A

syph
herpes zos
gonorrhea NO
chlamydia

31
Q

male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find

A

syph
herpes zos
gonorrhea NO
chlamydia

32
Q

irritative urinary symptoms may be found with which of the following conditions?

A

prostatitis and epididymitis

33
Q

of all of these treatments for herpes, which is the most useful for ASYMPTOMATIC viral shedding of herpes simlex type 2

A

valacyclovir

34
Q

diagnosis of ____ elevation of the scrotum improves the pain

A

epididymitis

35
Q

male presents with painless ulcer on his genitals. ulcer is indurated margin. what abx?

A

doxy
cef
azithro
cipro
NONE OF THE ABOVE

36
Q

male patient with chancre. you know that other conditions are commonly associated with chancroid. which of the following conditions would you expect to find

A

syph yes?
herpes zos
gonorrhea NO
chlamydia

ADULT EXAM 1 (17 decks)

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