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Phase 3a - GP > Sexual Health + Urology > Flashcards

Sexual Health + Urology Flashcards

1
Q

Define urge incontinence

A

aka overactive bladder - caused by overactivity of the detrusor muscle of the bladder.

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2
Q

Define stress incontinence

A

Weakness of the pelvic floor and sphincter muscles. This allows urine to leak at times of increased pressure on the bladder.

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3
Q

RF for urinary incontinence (4)

A

Increased age
Postmenopausal status
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions, such as multiple sclerosis
Cognitive impairment and dementia

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4
Q

What modifiable lifestyle factors that contribute to urinary incontinence/

A

Caffeine consumption
Alcohol consumption
Medications
Body mass index (BMI)

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5
Q

Ix for urinary incontinence

A
  1. Bladder diary - track fluid intake, urination episodes and incontinence over 3 days
  2. Urine dipstick
  3. Post-void residual bladder volume - bladder scan to assess for incomplete emptying
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6
Q

Stress incontinence management

A

Avoid caffeine, diuretics, excessive or restricted fluid intake

Supervised pelvic floor exercises

Surgery i.e. Tension-free vaginal tape (TVT)

Duloxetine is an SNRI antidepressant used second line where surgery is less preferred

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7
Q

Urge incontinence management

A

Bladder retraining (gradually increasing the time between voiding) for at least six weeks is first-line

Anticholinergic medication, for example, oxybutynin

Mirabegron - alternative anticholinergic medications

Invasive procedures - i.e. botox

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8
Q

Define retention

A

Inability to pass urine even when bladder is full usually caused by obstruction i.e. stones, BPH

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9
Q

What nerve is responsible for somatic control of micturition? and what part of the bladder does this nerve control?

A

Pudendal nerve (S2-S4)

Provides voluntary control over the external urethral sphincter - helps maintain continence during storage phase.

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10
Q

What nerve is responsible for autonomic control of micturition? and what part of the bladder does this nerve control?

A

Hypogastric nerve (T10 - L2)

Provides sympathetic innervation to the internal urethral sphincter and the detrusor muscle (bladder wall)

During storage phase:
1. Causes relaxation of detrusor muscle
2. Maintains tone of the internal urethral sphincter - to prevent unintentional leakage.

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11
Q

Describe micturition reflex during storage phase and voiding phase.

A

Storage phase:
1. sympathetic dominance inhibits bladder contraction
2. maintains sphincter tone
3. allowing the bladder to fill

Voiding phase:
1. parasympathetic activation leads to detrusor contraction
2. inhibition of the sphincters
3. facilitating urine expulsion

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12
Q

LUTS - storage phase Sx

A

F - frequency
U - urgency
N - nocturia
I - incontinence

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13
Q

LUTS - voiding phase Sx

A

S - straining
H - hesitancy
I - intermittency
P - poor stream
D - dribbling

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14
Q

What is cystitis?

A

Inflammation of the bladder

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15
Q

Why is UTIs more common in women?

A

Urethra is much shorter, making it easy for bacteria to get into the bladder.

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16
Q

Sx of lower UTI

A

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul smelling urine
Confusion is commonly the only symptom in older and frail patients

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17
Q

What is pyelonephritis and how does it occur as a result of lower UTIs?

A

Inflammation of the kidney. Lower UTIs can spread up to the kidneys and cause pyelonephritis.

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18
Q

Difference in Sx from px with pyelonephritis compared to lower UTI?

A

Fever
Loin/back pain
Nausea/vomiting
Renal angle tenderness on examination

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19
Q

Ix for UTIs

A
  • Urine dipstick:
    Presence of nitrites or leukocytes + RBCs = px likely to have UTI.
  1. Nitrites – gram -ve bac break nitrates (normal urine waste) to nitrites
  2. Leukocyte esterase - WBCs
  3. RBCs - haematuria
  • Midstream urine (MSU):
    microscopy, culture and sensitivity testing will determine the infective organism
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20
Q

Cx of UTI

A

MC - Escherichia coli

Other -
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)

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21
Q

Tx of UTI (cystitis)

A

Trimethoprim (avoid in patients in 1st trimester)
Nitrofurantoin (avoid in patients in 3rd trimester)
Amoxicillin or cefalexin used instead

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22
Q

Why is nitrofurantoin avoided in third trimester?

A

Risk of neonatal haemolysis (destruction of the neonatal red blood cells).

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23
Q

Why is trimethoprim avoided in first trimester?

A

Folate antagonist → cause congenital malformations, particularly neural tube defects (e.g., spina bifida).

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24
Q

What bacteria causes chlamydia? What kind of bacteria is it? Intra or extra cellular?

A

Chlamydia trachomatis = gram-negative bacteria.
Intracellular organism = enters + replicates within cells before rupturing the cell and spreading to others.

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25
Q

RF for developing chlamydia?

A

Young
Sexually active
Multiple partners

26
Q

What programme has Public Health England set out to detect chlamydia?

A

National Chlamydia Screening Programme (NCSP) - aims to screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner.

27
Q

Sx of chlamydia in women?

A

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)

28
Q

Sx of chlamydia in men?

A

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

29
Q

Examination findings of chlamydia in females?

A

Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

30
Q

Ix of chlamydia?

A

Nucleic acid amplification tests (NAAT) are used to diagnose chlamydia:

Vulvovaginal swab
Endocervical swab
First-catch urine sample (in women or men)
Urethral swab in men
Rectal swab (after anal sex)
Pharyngeal swab (after oral sex)

31
Q

Tx of chlamydia?

A

1st line - Doxycycline 100mg BD for 7 days.

If contraindicated use:
Azithromycin
Erythromycin
Amoxicillin

32
Q

When is doxycycline contraindicated?

A

In pregnancy and breastfeeding.

33
Q

Complications of chlamydia? (3)

A

Chronic pelvic pain
Infertility
Ectopic pregnancy
Conjunctivitis
Lymphogranuloma venereum

If pregnant:
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

34
Q

What is lymphogranuloma venereum?

A

Cdtn affecting the lymphoid tissue around the site of infection with chlamydia.

35
Q

RF for LGV (lymphogranuloma venereum)?

A

Men who have sex with men (MSM).

36
Q

Describe 3 stages of LGV?

A

Primary stage - Painless ulcer (penis, vaginal wall or rectum)

Secondary stage - Lymphadenitis (swelling + pain in lymph nodes infected i.e. inguinal or femoral nodes)

Tertiary stage - inflammation of the rectum (proctitis) + anus → change in bowel, tenesmus

37
Q

Tx for LGV?

A

1st line - Doxycycline

38
Q

What is chlamydial conjunctivitis?

A

Conjunctival infection when genital fluid comes in contact with eye.

39
Q

What kind of bacteria is Neisseria gonorrhoeae?

A

Gram-negative diplococcus bacteria

40
Q

How does gonorrhoea spread? Where are the infected areas?

A

STI that spreads via contact with mucous secretions from infected areas such as endocervix in women, urethra, rectum, conjunctiva and pharynx.

41
Q

Sx of gonorrhoea?

A

Female:
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

Male:
Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)

42
Q

Ix for gonorrhoea?

A

Nucleic acid amplification testing (NAAT) - detect the RNA or DNA of gonorrhoea.

Standard charcoal swab for microscopy, culture and sensitivities - to choose abx

If genital infx - endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample.
MSM - rectal and pharyngeal swab

43
Q

Tx of gonorrhoea?

A

IM ceftriaxone - if unknown sensitivities
Oral ciprofloxacin - if sensitivities known

Other tx:
abstain from sex for 7 days
do a follow up test of cure due to high abx resistance

44
Q

What are some conditions that HSV is responsible for causing?

A

Cold sores (herpes labialis)
Genital herpes
Herpes keratitis (infl of cornea in eye)
Herpetic whitlow (painful skin lesion on finger)

45
Q

How is HSV spread?

A

Through direct contact with affected mucous membranes or viral shedding in mucous secretions.

46
Q

What are the different strains of HSV?

A

HSV-1
HSV-2

47
Q

Describe sx of herpes labialis (oral herpes) and genital herpes?

A

Herpes labialis:
Tingling and burning followed by development of vesicular then ulcerative lesions involving the oropharynx and perioral mucosa.

Genital herpes:
Asymptomatic to tingling and burning without lesions, to recurrent genital ulcerations.

48
Q

Typical tx used for HSV outbreak?

A

Antivirals - Aciclovir, famciclovir, and valaciclovir

49
Q

What kind of virus in influenza?

A

RNA virus

50
Q

What are the 3 types of influenza?

A

A, B and C
A and B - MC

51
Q

Typical sx of influenza

A

Fever
Lethargy and fatigue
Anorexia (loss of appetite)
Muscle and joint aches
Headache
Dry cough
Sore throat
Coryzal symptoms

52
Q

Difference between common cold and flu (influenza)?

A

Flu - abrupt onset, fever, “wiped out” with muscle aches and lethargy

Common cold - gradual onset, no fever, can usually continue many activities

53
Q

Tx of someone at risk of complications of influenza?

A

Oral oseltamivir
Inhaled zanamivir

Otherwise self-care measures

54
Q

What is infectious mononucleosis (IM) also known as and what virus is it caused by?

A

aka glandular fever - infection with the Epstein Barr virus (EBV).

55
Q

How is IM (glandular fever) spread?

A

Virus found in saliva of infected person therefore spread by kissing or by sharing cups, toothbrushes and other equipment that transmits saliva.

56
Q

What does an adolescent presenting with a sore throat and then develops an itchy rash after taking amoxicillin have?

A

IM - Mononucleosis causes an intensely itchy maculopapular rash in response to amoxicillin or cephalosporins.

57
Q

Sx of IM

A

Fever
Sore throat
Fatigue
Lymphadenopathy (swollen lymph nodes)
Tonsillar enlargement
Splenomegaly

58
Q
  1. What antibodies does the body produce in response to IM?
  2. How long does it take for these antibodies to be produced?
  3. What 2 tests are done to find these antibodies?
A
  1. heterophile antibodies
  2. takes up to 6 weeks
  3. Monospot test - uses RBC’s from horses and Paul-Bunnell test - uses RBC’s from sheep
59
Q

Tx of IM

A

Self-limiting
Patients are advised to avoid alcohol, as EBV impacts the ability of the liver to process the alcohol. Patients are advised to avoid contact sports due to the risk of splenic rupture.

60
Q

What is Lyme disease and how is it transmitted?

A

An infectious disease transmitted to humans through the bite of infected ticks.

61
Q

Sx of Lyme disease?

A

Erythema migrans:
Typical rash that occurs 1 to 2 weeks after a tick bite
Central clearing
+
Constitutional sx:
Fever, headache, myalgias, fatigue, or arthralgias

62
Q

Tx of Lyme disease?

A

Single dose abx prophylaxis i.e. doxycycline

Phase 3a - GP (15 decks)

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