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CP2 OBGYN > Urogaenocology > Flashcards

Urogaenocology Flashcards

1
Q

Sx cystitis (6)

A 
Freq + nocturia 
Dysuria 
Urgency 
Haematuria 
Smelly urine 
Strangury
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2
Q

Sx pyelonephritis (6)

A 
Loin pain 
Rigors 
Vomiting 
Fever 
Dysuria 
TachyC
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3
Q

Why is pregnancy is predisposing factor to cystitis?

A

Progesterone –> marked dilation of calyces, renal pelvis + ureters
VUR occurs >

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4
Q

Why must you treat UTI’s in pregnancy ASAP?

A 
--> premature labour 
Sepsis 
Anaemia 
LBW 
Incr perinatal morbiidity, mortality
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5
Q

Why are post partum women particularly vulnerable to UTI’s? (3)

A

Trauma to bladder
Incomplete emptying
Intro of bacteria via catheter

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6
Q

What must be done to women’s urine if post partum and you suspect UTI?

A

MSU

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7
Q

Ix Upper UTI (5)

A 
Urine dipstick 
Midsstream MCS
USS (scarring/obstruction) 
CT/IV urography 
MSU
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8
Q

General advice for Tx UTIs (5)

A 
Drink plenty of fl 
Wipe - front --> back 
Don't wear occlusive underwear 
Do not delay urination 
D-mannose, cranberry / urine alkalising products
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9
Q

1st line Mx - non-pregnant women - UTI

A

PO nitrofurantoin - 100mg b.d 3 days

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10
Q

2nd line Mx - non-pregnant women - UTI

A

Fosfomycin

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11
Q

1st line Mx - pregnant women - UTI

A

Immediate Abx prescription nitrofurantoin 100mg b.d 7 days

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12
Q

2nd line Mx - pregnant women - UTI

A

Amoxicillin or cefalexin

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13
Q

Clinical relevance of round ligament - compositino

A

No mm fibres

Buut lymphatic - spread cancer to vulva

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14
Q

Inn of urinary continence

A

Pudendal nn S2-4

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15
Q

What are the pelvic floor muscle names (5)

A

Levator ani
Internal obturator
Piriform mm
Superficial + deep perineal mm

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16
Q

Urethrocoele

A

Prolapse of urethra into vagina

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17
Q

Cystocoele

A

Prolapse of upper anterior wall of vagina

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18
Q

Enterocoele

A

True hernia of the pouch of Douglas

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19
Q

Rectocoele

A

Weakness in levator ani mm –> bulge in mid post vaginal wall

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20
Q

1st degree uterine descent

A

If cervix is half way down vagina

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21
Q

2nd degree uterine descent

A

If cervix reaches vaginal opening

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22
Q

3rd degree uterine descent

A

If out of body

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23
Q

Where must the bladder neck be in order for a woman to be continent?

A

Above levator ani muscle

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24
Q

what are the 5 things a woman must have to have urinary continence?

A 
Functioning sphincter 
Properly positioned bladder neck
Thick urethral mucosa 
Compliant bladder 
Higher centre control
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25
Q

RF genuine stress incontinence (5)

A 
Increasing age 
Increasing parity 
Genital prolapse 
Postmenopausal status 
Prev pelvic floor surgery
26
Q

RF - destrusor instability (5)

A 
Age 
Hx of nocturnal eneuresis 
Neurological Hx 
Previous incontinence surgery 
Dx Hx
27
Q

Central neurological causes of voiding difficulties (2)

A

CVA

PD

28
Q

Spinal neurological causes of voiding difficulties (2)

A

SC injury

MS

29
Q

Peripheral neurological causes of voiding difficulties (2)

A

Prolapsed IV disc

Peripheral autonomic neuropathy

30
Q

Which places are the ureters most commonly damaged following hysterectomy?

A

Segment closest to bladder + in pelvis (distal 1/3 ureter)

31
Q

Congenital causes of genital prolapse (2)

A

Spina bifida

Connective tissue disorder

32
Q

Acquired causes of genital prolapse

A

Obstetric factors
PM atrophy
Chronically raised IAP
Iatrogenic

33
Q

q to ask - stress incontinence

A

Do you leak when you cough/sneeze?

34
Q

q to ask - urge incontinence

A

Do you struggle to get to the toilet in time?

35
Q

q to ask - dribbling incontinence?

A

Is it coming out all the time?

36
Q

What is a red flag with urinary incontinence?

A

Haematuria

37
Q

What is the key phrase with prolapse

A

Something coming down/dragging

38
Q

PS cystocoele

A

UTI
Have to pee uphill
NO haematuria

39
Q

PS uterine prolapse

A

Pain on sex
Back ache
Lower abdo dragging pain
No PMB

40
Q

PS rectocoele

A

Constipation
Digitation
No rectal bleeding or tenesmus

41
Q

Obstetric factors - prolapse (5)

A 
Prolonged labour 
Precipitate labour 
Instrumental delivery 
Fetal macrosomia 
Incr parity
42
Q

Which 2 drugs should you think about when pt has affected destrusor function

A

AntiD - Imipramine

Major tranqs

43
Q

Ix - urinary continence

A

Urodyanmics - mainstay
Cystoscopy
If suspect fistula - radio + dye

44
Q

Complications urinary incontinence (3)

A

Psychological issues
Excoriation/soreness bulba
Overdistention bladder –> denervation + necrosis detrusor mm

45
Q

Ix prolapse

A

MSU

Urodtamics

46
Q

Conservative Mx - stress incontinence (4)

A

Decr wt
Stop smoking/address chronic cough
Decr fl intake if excessive
Pelvic floor mm training

47
Q

Medical Mx stress incontinence

A

Duloxetine

Injectable periurethral bulking agents

48
Q

Surgical Mx stress incontinence

A

TVT
TOT
(mid-urethral sling procedure)

49
Q

What is TVT

A

Tension-free vaginal tape
tape in U shape under mid-urethra
Tension adjusted to prevent leakage
minimally invasive

50
Q

What is TOT

A

Trans-obturator tape

51
Q

Benefit TOT over TVT

A

TOT - < chance bladder perf

52
Q

Conservative Mx - destrusor instability (3)

A

Decr fl/avoid caffiene
Review meds
Bladder training

53
Q

Medical Mx - destrusor instability

A

Anticholinergics
oestrogens
Botulinum toxin A

54
Q

Surgical Mx destrusor instability

A

Clam augementation ileocystoplasty

55
Q

Mx - prolapse prevention

A

early recognition obstructed labour
Avoid long 2nd stage labour
Pelvic floor exercises post birth

56
Q

Tx - prolapse

A

Lose weight
Stop smoking
Physiotherapy
Pessaries

57
Q

Risks - pessaries (4)

A

Ulceration
Painful
Urinary retention
Fall out

58
Q

Apical/uterine prolapse - surgical Mx (2)

A

Vaginal hysterectomy

Hysteropexy

59
Q

Vaginal vault prolapse - surgical Mx (2)

A

Sacrocolpopexy

Sacrospinous fixation

60
Q

Vaginal wall prolapse - surgical Mx

A

Colporrhapy - anterior for cystoecoele

Posterior for rectocoele

CP2 OBGYN (21 decks)

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