Test 3: GU, GI Flashcards
Normal bleeding with menstrual interval < 21 days
polymenorrhea
infrequent bleeding; menstrual interval > 35 days
oligomenorrhea
excessive flow, saturating more than 1 pad an hr.
menorrhagia
decreased menstrual flow
hypomenorrhea
any female who presents with vaginal bleeding should have a
hCG
primary amenorrhea is the absence of ever initiating a period by
age 16
primary amenorrhea can be caused by
hypothalamic-pituitary-ovarian (HPO) disorders
causes of secondary amenorrhea
pregnancy, anorexia, stress, chronic illness, hypothyroidism, long distance runners, ballerinas
ectopic pregnancy is most common between ages
25-34 years
risk factors for ectopic pregnancy
hx of PID or tubal surgery, previous ectopic pregnancy, infertility, IUD use, smoking
S/S of ectopic pregnancy
low back or abd pain, adnexal or cervical motion tenderness
diagnosis of ectopic pregnancy is confirmed by
positive hCG test and US
difference in hCG levels with regular pregnancy and ectopic
in ectopic pregnancy, hCG levels increase up to 4-6 weeks then plateau or decrease.
discharge with bacterial vaginosis
white, thin, fishy smell
bacterial vaginosis on saline wet mount
epithelial cells with stippled borders
diagnosis of bacterial vaginosis
saline wet mount, KOH test, vaginal pH > 4.5
candida vulvovaginitis is not a
STD
bacterial vaginosis most commonly spread by
sex
vulvovaginitis is most commonly caused by
candidia albicans
risk factors for candida albicans
atbx therapy, corticosteroid, pregnancy, hypothyroidism, DM, anemia, oral contraceptives, wearing tight-fit clothing
discharge in candida vulvovaginitis
thick, white, curdy, malodorous
S/S of candida vulvovaginitis
itching, pain or urination, dyspareunia
when the mucosa can bleed when the white patches are scrapped off
candida vulvovaginitis
Diagnosis of candida vulvovaginitis
KOH
atrophic vaginitis is associated with
urinary incontinence.
atrophic vaginitis is usually caused by
estrogen deficiency
s/s of atrophic vaginitis
vaginal dryness, itching, blood-tinged discharge, bleeding after sex, pale vaginal walls.
wet prep in atrophic vaginitis shows
regular flora
trx for atrophic vaginitis
hormone replacement therapy
pain with menses
dysmenorrhea
results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
primary dysmenorrhea
caused by congenital anomaly of uterus or vagina; include endometriosis, adenomyosis, PID, and endometrial polyps.
secondary dysmenorrhea
When pain occurs during first 2 days of menses with suprapubic pain, N/V
primary dysmenorrhea
In primary dysmenorrhea, the physical and pelvic exam should always be
normal.
a result of STI of the fallopian tubes and ovaries
pelvic inflammatory disease.
PID is most common in women
younger than 35 and sexually active.
S/S of PID
bleeding, abd pain, fever, cervical motion and adnexal tenderness
complication of PID
peritonitis
diagnostics of PID
elevated WBC and ESR
fibroadenomas are common in women ages
15-25
Single, nontender, round, rubbery, mobile, and firm mass.
fibroadenoma
diagnostic of fibroadenoma
mammogram, US
fibrocystic changes are common in women ages
25-50
bilaterally, round, nodular, ropelike masses with breast engorgement.
fibrocystic changes
the different between fibroadenoma and fibrocystic changes is that
fibrocystic changes fluctuate in size and transient; fibroadenomas do not vary in size.
s/s of fibrocystic breast changes
benign cysts, nipple discharge, and breast tenderness.
nonpharm trx for fibrocystic breast changes
wear bra 24 hours a day, cold compress
galactorrhea
nipple discharge
nipple discharge is more commonly caused by
benign lesions
causes of nipple discharge
herpes zoster, pituitary disorders, phenothiazines, methyldopa, antidepressants
unilateral bloody nipple discharge may be
intraductal papilloma
mastitis is usually caused by
staph aureus
s/s of mastitis
painful, hot, red breast; fever, purulent discharge
complication of mastitis if not treated
abscess
mastitis most often affects
primigravidas
important education about mastitis
don’t stop breastfeeding unless abscess forms.
s/s of breast cancer
single unilateral lump that is hard, nontender, and immobile.
cancerous breast lumps occur mostly in the
RUQ
signs a breast tumor has become malignant
attaches to chest wall causing retractions, increases in size, dimpling of breast, nipple discharge, axillary lymphadenopathy.
caused by sudden obstruction of a ureter
renal colic
when increased abdominal pressure cause bladder pressure to exceed urethral sphincter tone or poor support of bladder neck.
stress incontinence
Momentary leakage of small amounts of urine with coughing, laughing, and sneezing while the person is in an upright position.
stress incontinence
not associated with pure stress incontinence
desire to urinate
strong, uncontrolled detrusor contractions that causes urgency following involuntary leakage
urge incontinence
large-volume incontinence
urge incontinence
causes of urge incontinence
stroke, brain tumor, dementia
when PVR is normal
urge incontinence
when PVR is > 100 ml
overflow incontinence
when neurologic disorder or anatomic obstruction limits bladder emptying until the bladder is overdistended. Detrusor contractions are insufficient to overcome urethral resistance.
overflow incontinence
A continuous dripping or dribbling with decreased force of stream.
overflow incontinence
causes of overflow incontinence
BPH, peripheral nerve disease, diabetic neuropathy
In men, painful urination without frequency or urgency suggests
urethritis
meds that can cause incontinence
sedatives, hypnotics, diuretics, anticholinergic agents, alpha-adrenergic agonists, CCB
reversible risk factors that can cause incontinence
o Delirium, dementia, depression o Infection o Atrophic vaginitis/urethritis o Pharmaceuticals o Endocrine/excess urine production o Restricted mobility o Stool impaction
when hernia sac protrudes directly through the abd wall
direct inguinal hernia
This type of hernia bulges anteriorly and pushes the side of the finger forward.
direct inguinal hernia
This type of hernia comes down the inguinal canal and touches the fingertip.
indirect inguinal hernia
this hernia descends down into the scrotum
indirect inguinal hernia
s/s of strangulated hernia
colicky abd pain, N/V, and abd distention.
hernia most common in females
femoral hernia
common cause of pyelonephritis
E. coli
risk factors for pyelonephritis
UTI, catheter, DM, eldelry, BPH, pregnancy
S/S of pyelonephritis
fever, chills, N/V, flank pain, hematuria, dysuria, +CVA tenderness
diagnostics for pyelonephritis
CBC shows leukocytosis, white cell casts in urine
most common cause of urethritis in men
gonorrhea
s/s of urethritis in females
asymptomatic
s/s of urethritis in men
dysuria, fever, discharge, suprapubic discomfort.
pt comes in with s/s of urethritis, you should
test for gonorrhea and chlamydia
yellow-green urethral discharge indicates
gonococcal infection
mucoid-like urethral discharge indicates
chlamydia
pyuria is
> 5 WBC per HPF in urine
testing to diagnose gonorrhea and chlamydia in urethritis
DNA testing and gram stain/culture
any patient with STD needs to have all partners tested who have had sexual contact in the past
60 days
common causes of cystitis (UTI):
E. coli, Proteus mirabilis, Klebsiella pna, Enterobacter, or staph
this symptom is usually absent in adults with cystitus
fever
diagnosis of cystitus
UA positive for leukocytes and nitrites.
risk factors of urolithiasis
alkaline pH of urine, calcium supplementation, thiazide diuretic, gout, high animal protein diet
S/S of urolithiasis
back/flank pain, hematuria, dysuria, N/V, + CVA tenderness
gold standard for dx urolithiasis
spiral CT
if urine pH < 5.5, stone is mostly
uric acid
if urine pH > 5.5, stone is likely
struvite
How long does glomerulonephritis occur after staph group A beta infection?
1-3 weeks
s/s of glomerulonephritis
previous strep infection, hematura, proteinuria, edema, HTN, abd/flank pain
diagnosis for glomerulonephritis
antistreptolysin O (ASO) is increased,
recurrence of glomerulonephritis
rare because immunity develops after first episode.
glomerulonephritis trx
self-limited: low salt and fluids, loop diuretics, antihypertensives.
common causes of acute prosatitis
E coli, pseudomonas, Klebsiella, Proteus, chlamydia, and gonorrhea
risk factor for acute prostatitis
sexual activity
s/s of acute prostatits
fever, dysuria, low back pain.
prostate in acute prostatits
tender, swollen, “boggy”, and warm.
Important with acute prostatits
do not massage as it can cause septicemia
diagnostic for acute prostatitis
UA shows wbc, bacteria, and hematuria
trx for acute prostatitis
use condoms until resolved, good hydration
causes of chronic prostatis
recurrent UTIs.
s/s of chronic prostatitis
asymptomatic, no tenderness of pain to prostate.
risk factors for prostate cs
family hx, african american
screen those high risk for prostate cancer at
45
s/s of prostate cancer
mostly asymptomatic
prostate in prostate cancer
hard, asymmetrical nodule.
diagnostic for prostate cancer
US, PSA level
testicular cancer most commonly occurs in
men 15-34.
risk factors for testicular cancer
crytorchidism, inguinal hernia, HIV positive, hydrocele as child
S/S of testicular cx
solid, firm, nontender testicular mass, gynecomastia, mass does not transilluminate.
gold standard for diagnosing testicular cx
scrotal ultrasound
trx for testicular cx
radiation/chemo, radical orchiectomy
avoid these meds with BPH
sympathomimetic or anticholinergic meds
gold standard trx for BPH
TURP
Twisting of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum.
testicular torsion
s/s of testicular torsion
unilateral scrotal pain, scrotal edema and redness, lower abd pain, n/v
cremasteric reflex in testicular torsion
absent
diagnostic for testicular torsion
doppler US shows reduced blood flow.
testicular torsion trx
surgical emergency
epididymitis in men < 35
chlamydia or gonorrhea
epididymitis in men > 35
bacterial UTI or prostatitis
s/s of epididymitis
gradual scrotal pain, urehtral discharge, dysuria, epididymitis is tender and enlarged, scrotal edema.
cremasteric reflex in epididymitis
present
diagnostic for epididymitis
normal blood flow
trx for epididymitis
elevate scrotum may relieve pain, cold compress
inflammation of the glans penis
balanitis
cause of balanitis
uncircumcised, poor hygeine
most common complication of balanitis
phimosis
when foreskin cannot be retracted over penis
phimosis
when phimosis is present at birth
resolves spontaneously by 3 years old.
Collection of abnormally large dilated “varicose” veins (usually the internal spermatic vein) in the scrotum, usually situated above the testes
varicocele
varicocele most commonly occurs in
left scrotum
s/s of varicocele
“bag of worms” separate from the testes
varicocele increases in size with
standing and valsalva maneuver
varicocele should prompt evaluation of
renal tumor
a collection of peritoneal fluid within scrotum
hydrocele
communicating hydrocele is common in
infancy and resolves within first year of life.
closure of the processus vaginalis which traps peritoneal fluid
noncommunicating hydrocele
hydrocele is associated with
indirect inguinal hernia
s/s of hydrocele
painless, scrotal swelling, transilluminate
trx for hydrocele
communicating- observation
noncommunicating- surgical drainage
s/s of appendicitis
anorexia, abd pain, N/V, fever
in appendicitis this occurs AFTER pain
N/V, constipation and diarrhea
Abd tenderness and rigidity over the right rectus muscle.
Mcburney’s point
pain in the RLQ during LLQ pressure
rovsing’s sign
increased lower quadrant pain when you press down on leg while pt pushes up
psoas sign
pain with internal rotation of flexed right thigh
obturator sign
perform this with suspected appendicitis
rectal exam in men and pelvic exam in women
when pain subsides temporarily with appendicitis, suspect
perforation
gold standard for diagnosing appendicitis
CT
refrain from doing this with appendicitis
heat to abd
most common cause of cholecystitis
obstruction of cystic duct by gallstone
s/s of cholecystitis
RUQ pain that may radiate to scapular area, anorexia, N/V, fever
risk factors for cholecystitis
pregnancy, rapid weight loss, obesity, high fat meals, increasing age
Abrupt cessation of inspiration on palpation of the gallbaladder
Murphy’s sign
gold standard diagnostic for cholecystitis
US, HIDA scan if US negative
epigastric pain that may radiate to the back or other parts of the abd
acute pancreatitis
positions with acute pancreatitis
supine makes it worse, leaning forward helps
s/s of acute pancreatitis
rebound tenderness, N/V, abd distention, fever
s/s of chronic pancreatitis
epigastric pain, steatorrhea
s/s of peritonitis
guarding, rigidity, rebound tenderness, percussion tenderness, N/V
involuntary contraction of the abdominal wall, often accompanied by a grimace.
guarding
an involuntary reflex contraction of the abdominal wall that persists over several examinations.
rigidity
s/s of hepatitis
malaise, fever, jaundice, dark urine
in all types of hepatitis, ____ are higher than ____
ALT; AST
transmission of hep a
food and water, fecal-oral route
transmission of hep b
blood/body fluids
marker to detect hep b
HBsAg
hepatitis vaccine given at birth
hep b
transmission of hep c
blood borne
there is no vaccine for hepatitis
c
transmission of hep d
blood-body fluids
only transmitted after infection with hep B
Hep D
transmission of hep E
fecal-oral
causes of intestinal obstruction
adhesions or hernias in small bowel; or cancer or diverticulosis in colon
s/s of small bowel obstruction
cramping, periumbilical pain with vomiting of bile/fecal material
s/s of large bowel obstruction
lower abd pain, constipation early, vomiting late
An emergent condition in which one bowel segment becomes invaginated into another
intussusception
intussusception is most common in
infants 6-12 months
risk factors for intussuception
hypertrophy of Peyer patches, Meckel’s diverticulum, recent viral URI or GI infection.
s/s of intussusception
colicky abd pain, vomiting, bloody stools resembling jelly
physical exam with intussusception
sausage-shaped mass in the RUQ
gold standard to diagnose intussusception
barium enema- shows “coiled spring” appearance
trx for intussusception
surgical reduction
risk factors for pyloric stenosis
family hx
s/s of pyloric stenosis
olive mass in RUQ, visible peristaltic waves while feeding, projectile vomiting
diagnostic for pyloric stenosis
US, upper GI series
s/s of IBS
abd pain, bloating, cramping, changes in bowel habits, mucus in stools
trx for IBS
lactose free diet, heat to abd, add bulk
constipation is
< 3 BMs/week for at least 12 weeks.
meds that can cause constipation
antidepressants, anticholinergics, CCBs, iron, diuretics, antacids, opiates
Congential absence of ganglion cells in a section of the wall of the large intestine resulting in lack of motility in that region, accumulation of feces, and dilation of the colon.
hirshsprungs
hirshsprungs is mostly associated with
trisomy 21 (down’s syndrome)
s/s of hirschsprungs
failure to pass meconium in 48 hours, constipation, abd distention, vomiting, poor feeding
diagnostics of hirschsprungs
CBC shows anemia and high WBCs, abd xray shows dilated loops of bowel, colonoscopy
trx for hirschsprungs
resection of bowel with possible colostomy
diagnostic criteria for GERD
endoscopy
causes of GERD
fatty meals, alcohol, chocolate, theophylline, CCB
atypical symptoms of GERD
cough, wheezing, hoarseness, laryngitis
peptic ulcer disease is caused by
H. pylori, NSAIDs, smoking, alcohol, age > 60
___ ulcer is more common than ___ ulcer
duodenal; gastric
s/s of duodenal ulcer
pain relieved by food, pain causes awakening at night.
s/s of gastric ulcer
N/V, pain worse with eating, weight loss
diagnostic for H. pylori
urea breath test
cullen’s sign
ecchymosis around umbilicus
causes of cullen’s sign
pancreatitis or ruptured ectopic pregnancy.
referred pain in epigastric upon pressure on McBurney’s point
Aaron’s sign
contraindications for the use of hormone replacement therapy in menopausal women is
unexplained vaginal bleeding
microscopic evaluation of candida vulvovaginitis reveals
hyphae
the benefit of topical of local estrogen for post-menopausal women is
reduced risk for UTIs
estrogen in a menopausal female increases risk for
endometrial cancer
symptom of chronic prostatitis
low back pain
a prostatectomy will result in a
low PSA level
hemorrhagic cystitis is characterized by
irritative voiding symptoms
most common sign of cholecystitis
vomiting
common causes of postmenopausal bleeding
hormone therapy, endometrial cancer
bleeding at irregular intervals or intermenstrual bleeding
metorrhagia
an episode of acute bleeding in a woman with normal regular menstrual cycles suggest
uterine fibroids
menorrhagia is common in women with
hypothyroidism
spontaneous abortion is most common at
10-12 weeks gestation
a patient with ectopic pregnancy usually reports to the clinic at
6-8 weeks gestation
uterine fibroids size after menopause
decrease
s/s of uterine fibroids
heavy menstrual flow, pain is not common.
s/s of endometrial cancer
painless vaginal bleeding and rapidly enlarging uterus.
bowel sounds over a scrotal mass is a
inguinal hernia
good way to check for hernias
raise head and shoulder while remaining supine
most common cause of infertility in men
varicocele
bacterial vaginosis is not a
std
common causes of gross (macroscopic) hematuria
pyelonephritis and urinary stones
cardinal symptom of uncomplicated UTI
dysuria
