Urogen Flashcards
1
Q
What is the definition of Impotence/erectile dysfunction
A
inability to attain or keep an erection sufficient for satisfactory sexual performance
2
Q
RFs /causes for ED
A
Lack of exercise, obesity smoking, alcoholism hypercholesterolaemia/hyperlipidaemia HTN DM Hx of penile #, trauma Surgery/RT to the pelvis or retro peritoneum
Drugs
- **Anatomical:
- Peyronie’s disease
- micropenis
Metabolic disease
- hypogonadism
- hyperprolactinaemia
- thyroid
- **- cushing’s
Neuro:
- brain lesion (stoke tumour, trauma, vasc)
- parkinson’s
- Spinal cord disease/injury
- intervertebral disc disease
Psychogenic
- GAD< depression
- situational- stress, partner
3
Q
what drugs may cause impotence
A
- antiHTN, Betablockers, diuretics
- antidepressants- tricyclics, SSRIs
- antipsychotics
- **- hormones- cyproterone, LH
- **- phenytoin, carbamazepine
- *- antihistamines
- H2 antagonists- cimetidine, ranitidine
- recreational
4
Q
What in the hx would suggest a psychogenic cause of ED
A
- sudden onset
- *- early collapse of erection
- self-stimulated or waking erections still present
- *- premature ejac or inability to
- problems/changes in relationship
- major life events
- psych hx
5
Q
What in the hx would suggest an organic cause for ED
A
- gradual onset
- normal ejaculation
- normal lipido (except hypogonadal men)
- RF in med hx- CVD, endocrine, neuro)
- operations, **RT, trauma to pelvis/scrotum/penis
- Current drug with SE EG
- smoker/ex
- *- high alcohol consumption
- *- recreational/bodybuilding drugs
6
Q
What should you exmamine in a man with ED
A
Endocrine
- testicular size
- secondary sexual characteristics
Neuro exam
Vascular
- peripheral pulses
- BP
- Full cardiovasc
Rectal- if >50
genitals
- Peyronie’s disease
- gonadal abnormalities
- retractile foreskin
7
Q
ix for ED
A
- fatsing glucose/hba1c/pipid profile if nt done in past year
- testosterone (hypogonadism)
- FSH, LH
- *- PSA
- prolactin if low testosterone
- vascular, neuro, endocrinology, pscyhological work ups for specialist to do
8
Q
management of ED
A
Testicular failure- testosterone
Pit/hypothalamic- tx cause
psycholigcal Therapies
1st LINE:
- Phosphodiesterase type 5 inhibitors- sildenafil, tasalafil
- Vacuum devices
2nd LINE:
- Intraurethral/topical/intracavernosal alprostadil (prostaglandin E1)
- intraurethral pellet about 15min before sex
- cream with plunger device, 5-10min before sex
- injection- may cause priapism
3rd LINE:
penile prosthesis- malleable/inflatable device inserted surgically
9
Q
How do phosphodiesterase type 5 inhibitors work
A
Sildenafil, tadalafil, vardenadil, avanafil
relaxes smooth muscles
10
Q
contraindication for using phosphdiesterase type 5 inhibitors
A
nitrites- may cause severe hypotension
11
Q
What types/grading of FGM are there
A
1- Clitoridectomy- partial/total removal of clit
2- Excision- partial/total removal of clit and labia minora +- excision of majora
3- Infibulation - narrowing of vaginal orifice with creation of a covering seal by cutting and appositioning labia +- excision of clit
4- All other harmful prcedures for non-medical purposes to female genitalia, including pricking, piercing, incising, scraping, cuaterisation
12
Q
What countries/continents does FGM occur
A
Africa
- East Africa- Somalia, Eritrea, Ethiopia, Egypt
- West Africa- Mali, Guinea, Sierra Leone
Middle East
- Turkey
- Syria
- Iraq
- Lebanon
- Israel
- Iran
- Saudi
- Yemen
- Afghanistan
- Pakistan
Asia
Latin America
Australia, NZ, UK
13
Q
What is the law concerning documentation and reporting of FGM
A
- you must record FGM in over 18y/os health records
Reporting:
- must do for all girsl <18
- must inform police by the close of the next working day
- includes genital piercings in girls <18
14
Q
Gynae complicaitons of FGM
A
- Dyspareunia, Sexual dysfunction, anorgasmia
- chronic pain
- Keloid scar
- Dysmenorrhea (incl. haematocolpos esp in T3- when blood cant exit, vagina fills)
- urinary flow obstruction, recurrent UTIs, urinary leakage
- PTSD
15
Q
Obstetric complications of FGM
A
- Difficulty conceiving
- Fear of childbirth
Increased rate of: - c-section - PPH - Episiotomy Severe vaginal lacerations - fistulas - Increased LOS
difficulty with
- vaginal exmaintions
- Applying fetal scalp electrodes
- Fetal blood sampling
- Catheterisation
16
Q
tx of FGM
A
Reversal of infibulation
- should be done preconceptually, antenatally or can be done during intra-partum
17
Q
What are the different kinds of inguinal hernias
A
Indirect- hernia enters canal through deep inguinal ring and exits through superficial ring
Direct- herniation through posterior wall of the canal, due to wall weakness
18
Q
What type of inguinal hernia is more likley to occur in a child/baby
A
Indirect- due to embryology rather than weakness
19
Q
describe how an indirect hernia occurs
A
Testicles descend/gubernaculum structure descends though the canal, from next to the renal structures.
As they descend, peritoneum is pulled down which makes the canal
connects testicles to abdo cavity
the tube is called processus vaginolis and is meant to close before birth
if not, bowel herniates through, causing swelling in labia/scrotum
20
Q
What are your main differentials for testicular/scrotal/inguinal swelling
A
Idiopathic scrotal oedema hydrocele torsion lymph nodes abscess
21
Q
what are sx of idiopathic scrotal oedema
A
children
redness/rash on one side of scrotum
rash may extend to peritoneum, anal canal, legs
not usually tender
22
Q
Difference between inguinal hernia and hydrocele, an don O/e
A
hydrocele- fluid in patent processus vaginolus
- transilluminates
- narrow neck
- fluctulant
hernia- bowel structure/ovary/fallopian tubes in through much wider patent vaginolus
- doesnt transilluminate (unless a neonate)
- often reducible
- wide neck
23
Q
how to tell the difference clinically between hydrocele and hernia
A
can you get behind the swelling?
- yes- you are feeling between swelling and external inguinal ring- hydrocele
- no- sweling is coming throgh canal- hernia
Transillumination
- in adults- hydrocele will shine through, bowel will not
- neck thickness (hernia=thick)
- reducibility- hernia is (mostly)
24
Q
tx of inguinal hernias
A
- surgically repair
- more urgent in children as more likely to suffer from strangulaiton, irreducibility, incarcerated
- do within days for neonates, within weeks for infants
25
What are the clinical features of an epididymal cyst
fluid filled
- feels smooth, spherical, well-defined
- transillumination
- extratesticular- cyst is palpable separately form the testicale (unlike a hydrocele)
- often multiple, BL
26
ix for ?epididymal cyst
If certain- none
if uncertain- scrotal USS
aspiraiton rarley needed
27
tx of epididymal cyst
most not needed
| resection if children in pain/cyst is large
28
What other conditions is epididymal cyst associated with
Polycystic kidney disease
CF
von Hippel Lindau (cystic formations in various places, genetic)
29
complications of epididymal cyst
torsion
| no risk of infections
30
What is a hydrocele
Fluid accumulation in the tunica vaginalis
31
causes of hydrocele in older pts
```
trauma
epididymo-orchitis
**hernia
**testicular torsion
variocele
testicular tumour
```
32
management of congential hydrocele
leave it unless uncomfrtable/huge- goes withing 1st 2 years of life
33
sx of hydrocele
- non tender may be uncomfortable if acute
- enlarged testicles, hangs lower
- smooth
- lies anteroinferioly to teh testis
- transilluminates
34
When would you investigate a hydrocele
tenderness
| internal shadows on transillumination
35
what ix may you do for ?hydrocele
- USS- for spermatoceles
- Doppler USS
- Serum alpha fetoprotein nd human chorionic gonadotropin- exclude malignancy
36
tx of hydrocele
- infant- observe until 2 years old- reassure
| - only do surgery if suspicion of inguinal hernia or other testicular pathology /large
37
What is a variocele
abnormal dilatation of testicular veins in pampiniform venous plexus
cuased by venous reflux
38
is variocele assoc with decreased ferility
yes, in 1/3- reduced testicular function
39
is hydrocele assoc with reduced fertility
no- not in itself, unless condition leading to it eg trauma, tumour- does
40
what side is variocele more common on- why?
Left
angle at which L testicular veing enters onto the L renal vein means there's a lack of effective valves between testicular and renal vein
R attaches to IVC directly
if renal cancer spreads into the L renal vein- it will prevent blood from draining from the L testicular vein into renal vein
R testicular vein drains into the vena cava, rather than the renal vein
41
clincial features of variocele
rarely causes pain- if so, it's throbbing/dull pain worse on standing
Dragging sensation
disappears when pt lies down
usually asymptomatic
'bag of worms'
usually found incidentally- infertility screning/routine medical exminations
42
exmiantion of variocele
have pt standing
affeted scrotum hangs lower than other
Valsalva manouvre whilst standing increases dilation further
dilation of veins is increased when staning compared to lying
43
Ix for variocele
sperm counts
doppler studies if physical exmination is inconclusive
- if ?RCC carcinoma-- USS/CT/MRI
44
tx fo variocele
observe with annyal examinations
bioflavonoids- slows progression- fruit, veg, nuts, wine ;)
Surgery
Advice:
- not likely will get LT complications-- 2/3 of men who have variocele have no issues conceiving
- supportiev underwear an simple analgesia can be used for discomfort
45
when to refer urgently with view of surgery for ?variocele
*- pain
- variocele appears suddenly
- doesnt drain when lying down
*- solitary R variocele
adolescents with
*- reduced testicular volumes (testicular growth arrest)
- if concerned about appearance and cannot be reassured in primary car
46
sx of pelvic inflamm disease
- Pelvic/lower abdo pain (usualy BL)
- RUQ pain- peri-hepatitis (fitz-hugh-curtis syndrome)
- deep dyspaerunia
- Abnormal vaginal bleeding (IMB, PC), Secondary dysmenorrhagia
Abnormal discharge
47
What is Fitz-high-curtis syndrome, sx
usually due to chlamydia
liver capsule inflammation leading to adhesions
acute onset RUQ pain
Aggravated by breathing, coughing, laughing
may be referred to R shoulder
tenderness on RUQ and percussion of lower ribs
N+V in 50%
48
signs of PID
Biman
- lower abdo tnderness (BL)
- adnexal tenderness
- may be palpable mass
- cervical motion tenderness
- uterine tenderness
Spec
- abnormal cervical/vaginal mucopurulent discharge
+-fever
49
Ix for ?PID
- pregnancy test- excludes ectopic
- hgih vag swab- for BV/candidiasis
- chlamydia/gonorrhoea, myciplasma genitalium tetsing
- HIV, syphillis bloods
- wet mount vaginal smear- pus cells-- if absent, PID unliklet
ESR, CRP, Leukocyte count
USS- could be done, not helpful if uncomplicated PID
Doppler USS- increased BF, not specific (eg endometriosis)
MRI or CT- not routine but could be useful if ?ddx
50
ddx for ?PID
Gynae
- ectopic
* *- threatened abortion
* *- ruptured corpus lutea cyst
* *- endometriosis
- ovarian csyt torsion/rupture/haemorrhage
- Mittelschmerz pain- ovulatory pain
GI
- IBS
* *- acute bowel perf
* *- Diverticular disease
- Appendicitis
**UTI
Functional- other longstanding general sx
51
Complications of PID
- infertility (tubal)
- ectopic
- chronic pelvis pain
- tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome
* *- Ovarian Cancer
52
management of ?PID
- pain- ibuprofen and para
ABX- all of the below
- ceftriaxone (gonorrhoea) 1g stat IM
- oral doxy 100mg (chalmydia) BD for 14 days
- oral metronidazole (BV, trich) 400mg BD for 14 days
IUD removal if no improvement in 72hours- with emergency contraception if needed
53
when should you admit urgently a pt with ?PID
- ectopic/appendicitis, tubo-ovarian cyst cannot be ruled out
* *- pt is pregnant
- severe N+V
- Fever >38
- signs of peritonitis- rebound rigidity, guarding
- immunocomprimised
* *- Fitz-hugh- curtis syndrome is suspected
54
What is phimosis
- inability to retract the foreskin
55
types of phimosis
physiological
- healthy prepuce
- inner mucosa everts through opening like a flower
- rarely causes sx
- can cause ballooning of foreskin when passing urine
pathological
- thickening, scarrning of foreskin
- no inner mucosal eversion
- can cause multiple sx
- due to BXO, balanitis
56
Management of physiological and patholigcal phimosis
reassurance- likely to resolve as boy grows older
- encourage genital hygiene- gently retract foreskin after bathing (skin made soft)
- dont force the foreskin
- corticosteroid cream for 4-6w to prevent need for circumscision
- circumcision if older/pathological
57
What si Balanitis Xerotica Obliterans
Lichen Sclerosis on males
| - genetic/autoimmune- not fully understood
58
sx/signs of balanitis xerotica obliterans
- white patches
* - scarring
- affecting glans, foreskin, urethra
- may have blistering/ulcers
* - haemorrhagic vesciles/purpura
* - meatal narrowing/thickneing
- phimosis
59
ix for ?BXO
clinical dx
biopsy if uncertain or is ?malignancy/no response to tx
***autoantibdy screen for autoimmune disease
60
tx BXO
- no cure
- potent topical steroids- clobetasol propionate 0.05% (mild)
intralesional triamcinolone steorid injections
refer if no repsonse to steroids after 3m/phimosis
procedures
- meateal /urethral dilatation
- meatoplasty
- grafting
- circumcision (relatively urgently)
61
sx of balanitis
```
redness/irritation of glans
may involve ofreskin too
pain
woth or without thick, clumpy discharge from under foreskin
+-phimosis
dysuria
bleeding
itching
```
62
causes of balanitis
- poor hygiene- irritation due to smegma
- tight foreskin preventing cleaning
- candida
- herpes, chlamydia, gonorrhoea
- condoms, soaps, scrubbing, washing powders
63
management of balanitis
```
- hygeine promotion
tx causes
- abx (doxy, ceftriaxone)
- antifungal cream clotrimazole
**- avoid irritant
**- trail steroid cream
- if recurrent- circumcision
```
64
what is the definition of a micropenis
scretched penile length -2.5SD of the mean in a pt with otherwise normal internal and external genitalia
Adult <3.6inch
prepubescent <1.5inch
neonate <0.75inch
sperm count.ability to become erect is sometimes affected
65
What syndrome can a micro penis be associated with
Kallman's
- no sense of smell
- hypogonadotropic hypogonadism
- cleft lip/palate
- short fingers, toes (esp ring finger)
66
what is peyronies disease
connective tissue disorder fo the penis
fibrous scar tissue/palques form in tunica albuginea in the corpus callosum
inflammatory thickening
fibrin deposition
increased collagen production
decreased quantity of elastic fibres
67
sx of peyronie's
- bent erect penis
- hour glass deformity with distal flaccidity
- painful erections
- palpable fibrotic plaque at site of angulation
68
ix of Peyronie's
clinical dx
| duplex USS occasionally to detect abnormalities
69
what conditions are peyronie's assoc with
```
dupuytrens
DM
ED
smoking, acloholism
lipid abnormalities, IHD, HTN
```
70
management of peyronie's
- self limiting- 1/2 of patients will get progressive disease, 1/2 will get tsatic disease
drugs
- para-aminobenzoate, vit E, colchicine, tamoxifen
- topical verapamil
- intralesional verapamil, interferon
Conservative
- external penile traction
- vacuum devices
surgery- disease must've been stable for 3m, risk of penile shortening
71
What is hypospadias
- congential
| - urethral meatus on shaft/mase of penis
72
what must you check o/e for hypospadias
both testes are palpable- excl. congenital adrenal hyperplasia
73
management of hyospadias
- surgical correction for normal void and sexual function
74
What is paraphimosis
foreskin is stuck in retracted position
75
Management of paraphimosis
Penile nerve block with lidocaine (ischaemia is painful), do before any of the following!
Compression- for 5-10mins
- hand around distal end to squeeze out oedema
2 thumbs on glans, index and ring finger under resticting band, apply pressure with thumbs and pull up with fingers
Osmotic methods
- gauze soaked in mannitol (hypertonic)
- do not do ice packs in gloves- cuases vasocontriction and makes it worse
Dundee methods- dorsal slit surgery, then offer circumcision for aesthetic
76
what tissue has ruptured in penile #
tunica albuginea
77
describe the internal tissue of the penis
corpus spongiosum- around urethra, at bottom
- corpus cavernosa- 2 larger bits above spongiosum, filld with blood when erect (contain carvernosal ateries)
- Tunica albuginea- fibrous layer that envelopes the corpus cavernosa and spongiosum , ruptues
- superficial dorsal vein, deep dorsal vein, dorsal arteries and dorsal nerve run superiorly
78
decsribe the journey of the sperm
made in testes
stored in epididymis and brings them to maturity
travel through vas deferans
seminal vesicles (which sit above prostate) inject 70% of the total volume of the semen (alkaline fluid, fructose, prostaglandins, clotting factors)
Prostate- produces and injects seminal fluid (proteins, hormones, vitamins, proteins, mucus)
ejaculated
79
Complications of penile #
deformity (angluation)
ED
**painful erections
**fistula
80
sx of penile #
```
snap/popping sounds
immediate loss of erection
blood at meaturs/blood in urine
retention
difficulty urinating (urethral injury)
pain
```
81
O/E of penile #
aubergine sign- blood contained in Buck's fascia- superficial layer , penis goes dark purple
- bruising can spread to peritoneum (butterflu ecchymosis)/lower abdo
- contralateral bending
82
tx of penile #
- surgical repair- evac haematoma, close defect, repair urethral injury around a catheter if present
post op counselling
- abstain from masturbatin/sex
- F/U if any complications
83
what is priapism
prolonged and peristent erection int eh absence of sexual desire lasting >4 hours
sickle cell children may get this
84
when is priapsim an emergency
ischaemia- PAIN
- obstruction if venous outflow
will cause irreversible ED
- penile compartment syndrom effectively
- thrombus formaiton and tissue damage
85
what is stuttering priapism
recurrent ischamei priapsim
often in sickle cell pts
will resolve with conservative measures (showers/exercise)
86
causes of ischaemic priapsim
```
idiopathic
intracavernosal prostaglanding injections for ED
sickle cell
thalassamia
leukaemia
```
cauda equina
spinal cord injury
**penile injury/trauma
drugs
- antids
- anticoags
- alpha blockers-doxazosin, tamsulosin
- antipsychotics , lithium
- testosterone, GnRH
* *- methylphenidate and other ADHD meds
* *- recreational
* *- alcohol excess
87
hx of priapism
need to diff between isch and non-isch- pain?
- onset
- duration
- ED present before ischaemia (importnat for medico-legal reasons)
PMHx
- sickle cell
- penile trauma
- thalassaemia
- Leukaemia
- strokes
- cauda equina
drugs
- antids
- antiphsychotics
- recreational
- ED injection
88
ix for priapism
intracavernosal aspiration- diagnotic and therapeutic (send off for testing)
Irrigation- move blots out
blood gas from aspiration
- low flow - low O2 and acidosis
- non isch- normal O2 and pH
bloods
- FBC
- Hb Electrphoresis (thalassaemia)
USS penis- coloured doppler for aterial flow
89
management of priapism
- intracavernosal aspiration and irrigation
- intracavernosal phenylepinephrine- sympathetic selective alpha agonist causes vessel constriction
if no response in an hour
- distal shunt
stuttering- input from haematologys- blood transfusion, home phenylepinephrine, LT management
90
When should a circumcision be considered? (generally)
- physiological phimosis not resolved at adolescnce
- painful ejaculation
- paraphimosis
- recurrent balanitis
- recurrent UTI
- BXO
91
ddx of acute scortal pain
```
Testicular torsion
torsion of hydatid
epididymo orchitis
trauma
acute hydrocele
****idiopathic scrotal odema
```
92
Sx of testicular torsion
- severe acute onset
- may feel sick/vomit
- testicle is teder to touch
- redness, swelling- LATE SIGNS
93
signs of tetsicular torsion
loss of cremasteric reflex
94
sx of torsion of appendix/hydatid or morgania
same as tetsicular torsion
- pain may be less severe
- pain may start in upper pole of the testis
- 1/3 of cases- blue dot in upper pole
- cremesteric reflex present!
95
when are the peaks of testicualr torsion
neonatal, adolescent
96
sx of idiopathic scrotal odema
- UL scrotal erythema and oedema
raised rash
in half of cases- extends to perineum, anal canal , legs
97
ix for ?idiopathic scrotal oedema
- USS_ thickening and oedema of scrotal wall, hypervadcularity, normal testes
98
tx of idiopathic scrotal oedema
```
self limiting (3-5d)
NSAIDS and Abx
```
99
causes of acute acquired hydrocele
trauma
epididymitis
testicular torsion/infarction
testicular neoplasm
100
sx of acute hydrocele
Rapid onset which is therefpre tender
| discomfort, heaviness
101
ix for ?acute hydrocele
USS- fluid
transilluminates
cause:
- urethral swab, urinaylsis/culture
- alphafetoprotein, hCG
- USS
102
Epididymo-orchitis- causes
- UTI- e.coli tracking down vas deferans
- STI- chlamydia, gonorrhoea
- Mumps- swelling of parotids, virus accesses testicle via blood streatm in 1 in 5 cases in Males
- post op infection eg prostatecomy
- amiodarone
- idiopathic
103
sx epididymo orchitis
```
onset over ~1 day
pain
swelling, enlarged scrotum
erythema
infection- dusyuria, discharge, fever, malaise
```
104
ix epididymo orchitis
- urine analysis
urine culture
urethral swab
105
Tx of epididymo orchitis
?STI- 1g ceftriaxone IM stat plus doxy BD for 10-14days without waiting for test results
* ***UTI
- ofloxacin 200mg BD 14days
advice-
- bed rest
- scrotal elevation (supportive underwear)
- analgesia
* *- stop amiodarone
106
What is bacterial vaginosis
when vaginal pH is >4.5 detah of normal vaginal microbiome and excess of others
107
Causative agents of BV
- Gardnerella vaginalis
- Mycoplasma hominis
- Lactobacillus rhamnosus
108
RFs for BV
- Sexually active
- concurrent STIs
- use of douches, deodorant, vaginal washes
- Menstruation
- Presence of semen in the vagina
- Copper intrauterine device
- smoking
109
Complications of BV
increased risk of acquiring STIs
late miscarriage, preterm labour/birth/RoM, low BW, postpartum enometriosis
110
sx of BV
1/2 are asymptomatic
grey/white discharge
thin and watery
strong fishy smell, particularly after sex
+-soreness or itchiness
111
What would you see O/E in someone with BV
thin, white, homogenous discharge coating walls of the vagina and vestibule
smell
112
tx of BV
non pregnant women with asymptomatic BV dont require tx
```
oral metronidazole (ok for pregnant women)
can have this intravaginally, or clindamycin cream
```
Advice to stay away from exposing factors where possible
113
What organism is chlamydia caused by histological appearance
Chlamydia trachomatis
obligate intracellular gram NEGATIVE, pink,BACILLI, pus cells
114
How is chlamydia transfered
vaginal, anal or oral sex
from infected mother to her baby after childbirth
eye infections may also spread via towels
115
sx of chlamydia
most are asymptomatic
sx may occur weeks later
women:
- vaginal discharge- white/cloudy/milky/wateryyellow/pus-like
- bleeding (PC, IMB)
- dysuria
- vulval soreness
men:
- white.cloudy/watery discharge
- dysuria
- pain/swelling on one.both testicles
116
what would the cervix look like O/E in woman with symptomatic chlamydia
inflamed
| mucopurulent discharge covering it
117
Ix for ?chlamydia
- endocervical or vulvo/vaginal swab for women
urethral swabs/first void urine for NAAT (nucleic acid amplificiation)
- pass med says vulvovagina is more sensitive for C&G over endocervical
118
What si the suggested screening for chlamydia
annually for sexually active women and men under the age of 25
1st prenatal visit
119
Complications of chlamydia (in non pregnant people)
- PID
- Tubal infertility
- Trachoma- blindness, repeated inf withotu tx
- Epididymo-orchitis
- Reiter's syndrome- cant wee, pee or climb a tree- conjunc, arthritis, urethritis
* *- SARA- polyarthritis of weight bearing joints with rash
- perihepatitis (Fitz-Hugh-Curtis)
* *- Lymphogranuloma venereum- lymphatic system infection
120
Complications of chlamydia in pregnant people
Chorioamnionitis- PROM
Neonatal conjunctivitis
Neonatal pneumonia
121
How do you take an endocervical swab
- use spec
| - rotate swab 360 degrees inside cervical Os
122
How do you take a vulvovaginal swab
insert swab ~5cm into vagina, rotate for 10-30sec
123
Instructions for first catch urine
need to have held urine for at least 1 hour
124
how to take urethral swab
put swab 2-4cm into urethra and rotate it once
125
What is the difference between a double and triple swab?
Double
- a NAAT swab (endocervical or vulvovaginal depending on local guidelines)
- a high vaginal charcoal media swab
triple
- NAAT swab (endocerv/vulvovag)
- high vaginal charcoal media swab
- endocervical charcoal media swab
126
What is a charcoal media swab for
High vaginal swab- BV, Trich, candida, Group B strep
Endocervical- gonorrhoea
127
What are vulvovaginal and endocervical NAAT swabs for
chlamydia, gonorrhoea- pass med says vulvovgainal is more sensitive
should be performed first in double/triple swab kits
128
Tx for chlamydia
Doxy 100mg BD for 7 days
in pregnant/breats feeding women
- azithromycin, amox, erythro
contact tracing and tetsing
test of confirmation esp in (3m after tx completion)
- pregnant women (3w after tx completion)
- diagnosed rectal infections
- <25s
- >25 at risk of reinfection
129
How long should someone not have sex for after being treated for chlamydia
1 week
130
What is the discharge like for BV
grey
smell like fish, unpleasant
thin/watery
other sx- +- ithcing, soreness
131
What is the discharge like in Trichomonas vaginalis
yellow/green!
thin, FROTHY
may have an odour! (fishy)
other sx- itching, irritation, dyspareunia
132
What is the discharge like in Gonorrhoea
green/yellow
blood
thick consistency
other sx
- painful/burning urination
- frequency
- sore throat
- changes in bleeding (F)
- dyspareunia
133
What is the discharge like in chlamydia
white/cloudy/yellow/watery/milky
bleeding
other sx
- dysuria
- dyspareunia
- unusual bleeding (F)
- sore throat
134
What is the discharge like in Candida infection
white
clumpy
cottage-cheese like
other sx
- itching soreness
inflammation
burning
135
What is the discharge like in perimenopause
irregular bleeding
other sx
- hot flushes, chills
- mood swings
- sleepign issues
- wt gain
- thinning hair
136
What is the discharge like in cervical Ca
brownish/blood tinged
```
other sx
- PCB/IMB
- frequency
pelvic pain
dysuria
```
137
What is gonorrhoea caused by?
Neisseria gonorrhoeae
Gram NEGATIVE diplococci
138
sx of gonorrhoea
- often symptomatic
- usually between 2-14 days after exposure
- pus liek discharge
- White/yellow/greenish
- bleeding
- dysuria
Male
- swelling/redness at opening of penis (m)
- swelling of testicles
Female
- deeps dyspareunia
- sharp pain in lower abdo
- IMB, PCB, heavy periods
- pain in rectum if there
- sore throat
- conjunctivitis
139
Ix for gonorrhoea
NAAT swab
Endocarvical charcoal swab
of penis, vaginal, rectum, throat
if ?arthritis- aspiration for microscopy
if systemic features- blood microscopy
140
Complications of gonorrhoea
Men
* - scarring/stricture of urethra
- abscess in the interior of the penis
- reduced fertility or sterility
- epididymo-orchitis
Women
- subfertility
* *- ectopic pregnancy
* *- gonorrhoea infection to newborn
- PID
```
**- reiter's syndrome
if in bloodstream
- septic arthritis
- rash
- heart valve damage
- meningitis
```
141
tx of gonorrhoea
Ceftriaxone- IM 1g single dose
Azithromycin- oral 2g dose
STI and HIV screening
Advice
- abstain from sex 7 days after tx ahs finished
- pt lead partner notification
142
f/u of gonorrhoea
1w after tx has finished
143
risk to pregnant women having gonorrhoea
Spontaneous abortion
premture labour (PRoM)
- perinatal mortality
- gonoccocal conjuncitvities
144
tx of gonorrhoea in pregnanct/breatsfeeding women
ceftriaxone
azithromycin 2nd line
NOT fluoroguinolones
145
What is Type one herpes simplex Virus
Oral
- cold sores
- less severe
- has ~1 outbreak in 1st year
146
What is type 2 Herpes simplex virus
genital
more severe
~3 outbreaks in 1st year
147
sx of HSV
- clusters of yellow vesicles that pop to become ulcers
- slouging (labia fuse)
- v painful
- dysuria
- sometimes discharhe
- flu-like illness
- inguinal lymphadenopathy
- autonomic neuropathy- can go into retention
148
why does type 2 HSV have recurrent attacks
thought to be due to virus lying dormant in sacral ganglia- can be triggered by stress, sex, menstruation
149
ix of HSV
viral culture of vesicle fluid
150
tx for HSV
no cure
acyclovir to reduce severity of attack
- apply 5x per day for 5-10 days/oral 200mg 5x a day
- can be applied every 4 hours
- can have preventative tx if >=6 a year- 400mg BD for 6-12months
paracetemol, lidocaine
salt baths
151
complications of HSV during pregnancy
miscarriage
| neonatal herpes
152
complicaiotns of HSV
```
disseminated herpes (IV acyclovir)
Encephalitis
meningitis
***sacral radiculopathy (retention, constipation)
***Myelitis
```
153
Tx of herpes outbreak during pregnancy
Acyclovir - 400mg TDS for 5 days
| LCS if outbreak is from 29w gest. (3rd trimester)
154
What type of cells does hIV destroy
CD4 cells
155
What are the stages of HIV disease
Seroconversion/primary/acute
asymptomatic
symptomatic
Late stages/AIDs
156
What is the seroconversion stage of HIV
- up to 6w post infection
- minor sx (sore throat, fever, rash)
- often goes unnoticed
- most infectious at this stage
157
What is the asymptomatic stage of HIV
- can last several years
| - virus infecting host cells and replicating, damagign the immune system
158
What is the symptomatic stage of HIV
- secondary infections
* *- weight loss, night sweats,
- cancers
- swollen lymph glands
- long lasting diarrhoea
- fatigue
* *- mouth: dry, thrush, gingivitis, ulcers, HSV, canker sores
159
What is the late stage HIV
AIDS <200cells/mm3 CD4 count
160
What are the AIDS defining illnesses
GI
- Candidiasis of the esophagus, bronchi, trachea, or lungs
- Salmonella septicemia, recurrent
Resp
- TB
- pneumocystitis jiroveci pneumonia
- recurrent pneumonia
Eyes
- Cytomegalovirus retinitis (with loss of vision)
Brain
- Encephalopathy, HIV related
* *- toxoplasmosis of the brain
- Progressive multifocal leukoencephalopathy
Cancers
- Kaposi's sarcoma
- invasive cervical cancer
* *- non-Hodgkin's lymphoma
* *- Herpes simplex: chronic ulcer(s) (more than 1 month in duration); or bronchitis, pneumonitis, or esophagitis
- Histoplasmosis, disseminated or extrapulmonary
- CMV (other than liver, spleen, or nodes)
- HIV wasting disease
161
What cancers are more common in people with HIV, but not AIDs defining
cervical cancer
Hodgkin's lymphoma
Liver cancer (may be related to Hep B/C)
162
HIV testing
Antibody/third gen test
- blood, oral fluid or urine
- only effective AFTER seroconversion stage (3m after exposure)
Combined antigen/antibody test/4th gen
- antibodies and p24 antigens
- reliable 1m after exposure
163
What is Kaposi's sarcoma, sx
cancer of the lymph and blood vessels
- painless purplish, maculopapular on legs, skin, feet, face
- can alo appear in genital area, mough
164
tx of HIV
no cure- stops HIV replication by decreasing viral load to undetectable levels
Combination/highly active antiretroviral therapy (HAART)- should commence asap after diagnosis
durgs included are:
- nuleoside reverse transcriptase inhibitors eg emtricitabine, tenofovir
- integrase inhibitors
- non-nucleoside reverse transcriptase inhibitors
strict coherence is needed over lifetime
- pre-exposure prophylaxis (emtricitabine with tenofovir)
- post exposure prophylaxis (above plus raltegravir) for 28 days
165
What type of HPV cause warts
6, 11
166
tx of HPV warts
- Salicylic acid
- formaldehyde
- glutaraldehyde
- silver nitrate
- podophyllin- used for external soft, non keratinised warts
- imiquimod cream- for both keratinised and non keratinised
- cyrotherapy
- surgery
167
What types of HPV cause cervical pre-cancer/cancer
- 16, 18, 31, 33
most are type 16
168
what type of HPV is the gardasil vaccine against
6, 11, 16, 17
169
what types of cancers are also caused by high risk HPV types
penile
vulval
head
neck
170
What is the cervical screening programme
25-49- ever 3 years
50-64- every 5 years
65+- if last one abnormal
171
Indications for colpsoscopy
- genital warts
- cervictitis
- PCB
- smear results abnormal (CIN)/cervix grossly abnormal
- if had HPV positive on smear with normal cytology, they then get smear every year for 3 years, if all 3 years are abnormal and HPV persists- colposcopy
172
what does papanicolaou class 1 cervix mean
- no dysplasia
- no intraepithelial lesion/malignancy
- negative for CIN
- infection
173
what does CIN stand for
cervical intraepithelial neoplasia
174
what does class 2 cervix mean
- sqyamous atypia (dysplasia level)
- atypical squamous cells of undetermined significance
- HPV infection
175
what does class III cervix mean
- mild/moderate dysplasia
- CIN1/2
- Low grade squamous intraepithelial lesion
- precancer
176
what does class IV cervix mean
- severe dysplasia, carcinoma in situ
- CIN 3
- high grade squamous intraepithelial lesion
- precancer
177
what does class V cervix mean
- carcinoma
178
Management of pre cervical cancers
CIN1- further screenign to make sure HPV regresses and CIN1 resolves
CIN2- cut out the area- cyrotherapy, laser therpay, loop electrosurgical procedure
- CIN3- remove affected part of cervix- large loop excision of the transformation zone
179
What cell type is cervical cancer
Sq (most)
| adenocarcinoma
180
FIGO scoring system of cevrical cancer
I
A- not grossly visualised, microscopic
B- visualised, only on cervix
II
- invasion of surrounding organs and tissue
III
- distant lymph nodes ot tissue within the pelvis
IV
- distant mets
181
Management of cervical cancer
Ia
- take off the cells from cervix (loop electrosurgical excision procedure)
Ib
- radical hysterectomy- cervix, surrounding tissue and 3cm of vagina (fertility lost, nerve damage)
Stages 2+- RT, CT, palliative
182
What is lymphgranuloma venereum
- caused by 3 unique strains of chlamydia trachomatis
- infeciton of lymphatic system
- most common in MSM, HIV pts
183
sx of lymphogranuloma venereum
1. small, often asymptomatic genital skin lesion which later ulcerates- painless
2. followed by regional painfuul lymphadenopathy in groin/pelvis
3. Severe proctitis if anally acquired -->
- anal bleeding
- Anal pain
- diarrhoea
- Frequent/continuous need to defecate
- fullness, tenesmus
184
ix for lymphogranuloma venereum
rectal swab
185
tx of lymphogranuloma venereum
- doxy oral 100mg BD for 21 days
- give contacts the above tx
warn about photosensitivity , oesophageal ulceration
186
what causes genital pediculosis pubis
- pthirus pubis infestation
187
transmission of pediculosis pubis
- sex, bedding, clothing, towels
188
sx of pediculosis pubis
```
- intesne itcihng
grey/blue discolouration at feeding sights
eggs/lice visible
excoriation markes
crusting
scarring
secondary bacterial infection
```
rarely present in
- hair near anus
- beard
- armpit
- eyebrows
- eyelashes
189
tx of pediculosis pubis
- premethrin- whole of body for 12hours
- 2 rounds of tx at least 1 week apart to kill newly hatched
if on eyes
- premetrhin 1% lotion
wash bedding, clothing and towles in >=50 degrees centigrade water
contact tracing and tx
190
What is scabies caused by
sarcoptes scabbei mite
191
how are scabies transmitted
skin to skin contact, often during sex
192
sx of scabies
- track marks- silver lines with dot/scab at end of the line
- red rash which tunrs into red vesicles
- often in webbing of fingers, trunk, limb, genitalia
- intense pruritis, esp at night
193
tx of scabies
- premethrin 5%- coat skin for 12 hours, repeat in 7 days
- tx household
- hot wash bedding/ clothes, towels
194
What is crusted/Norwegian scabies
severe ascabies occurring in immunocomprimised people, elderly, or disabled
195
sx of Norwegian scabies
- thick crusting
| - intense itching
196
tx of Noerwegian scabies
- topic permethrin
| - oral ivermectin
197
What is syphillis caused by
Treponema pallidum
gram negative (pink/red) spirochete
198
what is the diseasecourse of syphillis
Primary
Secondary
Tertiary
199
What happens in primary phase of syphillis
- chancre- hard, painless
- at site of infection
- within 3w
- inguinal lymph
- resolves within 6w
- often not seen in women as lesion may be on cervix
200
What happens in secondary phase of syphillis
- 6-10w weeks after primary
- septiciaemia
- classic rash on palms, soles ro trunk- medium sized red/brown spots, flat
- lymphadenopathy
- anterior uveitis
- buccal snail track ulcers
- painless warty genital lesions (condylomata lata)
201
What happens in tertiary phase of syphillis
- if left untreated
- in about 40% is 3 years after, can be up to 40 years
- neurosyphillis- dementia
- CVD- aneurysm of aortic root (thoracic anuerysm)
- inflammatory plaques on skin/bones- gomata
- paralysis
- Argyll robertson pupil
202
ix of syphillis
- blood test- Rapid plasma reagin (RPR)
- spirochete in nasal discharge
- XR- perichondritis
- CSF- increase monocytes, protein positive
203
tx of syphillis
Infection of <2 years
- Benzathine benzylpenicillin stat IM 2.4million units
erythro or doxy if allergic, 14d
if asymptomatic for >2years
- benzathin benzylpenicillin IM 2.4million units, once weekly for 2 weeks
or doxy 28d
Asymptomatic contacys- doxy 14d
204
how to tx syphillis in pregnant woman
Benathine benzylenicillin stat IM 2.4million units, repeat after 1 week
205
sx of congential syphillis
- skeletal and teeth malformations (hutchinson (notched))
- meningitis
- keratitis, blindness
- nerve deafness
- rhinitis, rash
- hepatosplnomegaly, lymphadenopathy
- jaundice, anaemia
- hydrops (fluid in compartments- ascites, pleural eff, pericard eff, oedema)
206
tx of neonatal syphillis
baby- 3w benzathine benzylpenicillin IM
207
what is trichomonas vaginalis caused by
parasite
| motile flagellated protozoon
208
sx of trichomonas vaginalis
- many asymptomatic, men v rarely get sx
- men, infeciton passes after 7d
- women it persists for years
if sx appear, they will do so within 1m
- soreness- low abdo, vulval
- inflammation
- vulva ulceration
- vulval itching
- thick/thin/forthy yellow/green discharge
- strong unpleasant smell
- dyspareunia
Men
- urethral discharge- thin and white
- inflammation of foreskin sometimes
- prostatitis may occur
209
Complciaitons of trichomonas vaginalis
- PID
- prostitis
- enhances HIV transmission
- increased risk of TB if alos have HIV
- increase risk of HPV
if pregnant
- preterm
- LBW
- vertical transmission
210
ix of trichomonas vaginalis
- wet smear microscopy of vaginal secretions
- NAAT- better than above, swab taken from posterior vaginal fornix, can be self swab
- men- first void urine sample NAAT
211
tx of trichomonas vaginalis
nitromidazoles
- oral metronidazole 400-500mg BD for 1 week (ok in breastfeeding/pregnant)
or 2g stat dose oral metronidazole
212
sx of urethritis
urethral dicharge
dysuria
penile discomfort
mucus in urine (urinary threads)
213
Management of urethritis
tx empiriccally as chlamydia
- doxy 100mg BD for 1 week (or azithro)
if gonococcal suspected:
- ceftriaxone IM 1g stat (or azithro)
- f/u 1-2 w after tx
- contact tracing
214
classifications to urethritis
- gonococcal
- non gonococcal- in 1/2 has nto ID cause
- peristsent/recurrent- occurring >1m after tx, no ID cause usually
215
what two type of renal cancer are there
Renal cell carcinoma
- most common kidney cancer- which is most commonly clear cells
Transitional Cell /urothelial carcinoma
- cell type that makes up the pelvis, ureters, bladder and urethra
- rarely causes kidney cancer
- most common cause of bladder cancer
216
sx of prosatitis (acute)
- UTI sx- dysuria, frequency, urgency
- perineal, penile, rectal pain
- acute urinary retention- difficulty vioding, hesitancy, straining, weakn stream
- lower back pain
- pain on ejaculation
- rigors, arthralgia, myalgia, fever
217
signs of prostatitis
DRE
- warm, tender, swollen prostate
- NOTE- do NOT massage the prostate or palpate it too much as you risk causing
+-Sepsis, tachy
218
sx of chronic prostatitis
at least 3m of
- Pelvic, urogenital pain
- LUTS
- sexual dysfunction- ED, pain on ejac, haematospermia
- pain with bowel movmenets
- +- tender, enlarged prostate O/E (although DRE may be normal)
219
complications of prostatits
- abscess
- bacteraemia
- epididymitis
- pyelonephritis
220
Ix for ?prostatitis
- MSU, urine MC&S to confirm UTI
- do no collect prostate secretions, as massaging it can increase risk of sepsis
- blood cultures
- chlamydia and gonorrhoea NAAT (Endocerv or vulvovag)
- FBC
- Abdo exmaination
- DRE- gently!
221
why does prosatitis occur
- UTI usually (e.coli, enterobacteriae - klebsiella, enterobacter, proteus)
222
management of acute prostatitis
Abx
- cipro
- amikacin
- levofloxacin
- laxatives if pain on bowel movements
Advice
- paracetemol+- weak low dose opioid eg codeine
- NSAIDs
- fluids
- usually lasts several weeks
- seek help if sx worsen or dont improve within 48hours of abx
-
223
when to admit someone with prostatitis
Admit if:
- unable to take oral abx
- severe sx
- sepsis/acute retention/prostatic abscess sx
- no improvement in 48 hours after starting abx
Consider referral if:
- immunocomprimised
- DM
- pre-existing urological conditions- eg BPH, catheter
- STI is identified
224
management of chronic prostatitis
- alpha blockers- tamsulosin
- psychological support
- abx- longer course- trimethoprim/doxy 4-6w
- laxatives
225
f/u for prostatitis
- 48hours after abx started to check response and review abx after culture results
- admit if no improvement
- at 14d also - either stop or continue abx
- after recovery- refer for ix to r/o structural abnormality of UT
226
BPH cause
hyperplasia of stromal and epithelial cells
227
sx BPH
LUTS
- hesitancy
- urgency
- frequency
- weak flow, intermittency
- straining
- terminal dribbling
- incomplete emptying
- nocturia
228
ix for ?BPH
DRE- smooth, symmetrical, slightly soft, with central sulcus, >walnut size
- abdo- palpate bladder
- bladder diary
- urine dipstick
- PSA- unreliable
229
what is the PSA glycoprotein raised in
- prostate cancer
- BPH
- prostatitis
- UTI
- vigorous exercise (cycling)
- recent ejaculation
- prostate stimulation incl. DRE
230
tx BPH
- alpha adrenoreceptor blcoker- tamsulosin, doxazosin
- 5 alpha reductase inhibitor- finasteride, dutasteride
- surgery fro severe sx/unresponsive to meds
231
SE of alpha adrenoceptor blockers
ie tamsulosin, doxazosin
- postural hypotension
-- check their meds and lying/standing BP
232
SE of finasteride
5 alpha reductase inhibitor
| - sexual dysfunction
233
BPH surgeries
- transurethral resection of the prostate
- laser surgeries
- prostatic urethral lifts- small implants in prostate that lift excess prostate tissue away from urethra
- open prostaectomy
234
SE of BPH surgeries
- increased frequency/urgency
- haematuria
- urine infection
- weak flow
- retrograde ejaculation
- ED
235
cell type of prostate cancers
adenocarincoma (usually in peripheral zone of the prostate
236
sx of prostate cancer
- asymptomatic
- LUTS
- haematuria
- haematospermia
- ED
- wt loss, bone pain, CES- advanced
237
differentials of haematospermia
- vesiculitis (seminal vesicle inflammation)
- seminal vesicle cysts
- prostatitis
* *- recent urological surgery- biopsy, cystoscopy
* *- STI
* *- Severe HTN
* *- coagulopathy
- prostate cancer
- testicular cancer
* * - bladder cancer
- seminal vesicle calculi
238
ix for ?prostate cancer
DRE- hard, asymmetrical, craggy, irregular, loss of central sulcus, hard nodule(s)
- PSA raised (done if DRE abnormal)
- MRI- do before biopsy
- USS guided or transperineal biopsy
- isotope bone scan
239
risks of prostate biopsy
bleeding
infection
urinary retention
ED
240
grading system used for prostate cancer
Gleason
- histology grade of most prevalent pattern in biopsy + grady of second most prevalent pattern in biopsy
TNM
241
prostate cancer tx
- watch and wait
- RT- external beam, androgen deprivation therpay
- Brachytherapy- radioactive seeds in prostate
Hormone therapy
**- androgen receptor blockers- bicalutamide
**- GnRH agonists- goserelin
***^^^co prescribe with Anti-androgen treatment such as cyproterone acetate/flutamide
for 1st 3 w due to the risk of tumour flare.
- BL orchidectomy (rarely done
- prostatectomy
242
SE of hormonal tx of prostate cancer
- hot flushes
- sexual dysfunction
- fatigue
- OP
243
SE of prostatectomy
- urinary incontinence
| - ED
244
where does prostate cancer met to
bone- cord compression- urgent MRI spine- dexamethasone BD, PPI, bedrest, RT/neurosurgery
- lymph nodes
245
what is a vasectomy
- vas deferens cut, sperm cannot travel from testes/epididymis to be ejaculated
- les sinvasive than female sterilisation
- should be considered permanent, as reversals are not always successful
246
advice post vasectomy
- sue other forms of contraception for 2m post procedure
| - testing of semen needed before can be relied upon- 12w post op
247
infertility hx- qs to ask
Lifestyle
- tobacco smoking
- marijuana
- alcohol
- illicit drugs
* *- obesity
- stress levels
- Diet- hgihly processed foods/vit deficiency
- highly intensive exercise
- exposure to pesticides, lead, paint, solvent, radiation, heavy metal
**trauma to testicles
pmhx
- kidney failure
- mumps in past
- undescended testicles in past/present
* *- varioceles
- ejaculatory issues, ED
* *- chronic illness
- surgical- any urological surgeries (retrograde ejaculation sx screen - cloudy urine after sex)
- RT/CT exposure
Drugs
- anabolic steroid use
Puberty
- age
- secondary sexual characteristics
248
ix for male infertility
Semen
- sperm count
- motility
- morphology
- repeat in 3m if abnomral as illness can affect
- examination- gentitalia, secondary sexual characteristics
* *- smears, swabs- STI
- FSH, LSH
- prolactin
* *- karyotyping
* *- CF screen
* *- testicular biopsy if azoospermia
- vasogram
- USS
249
what does high FSH and low testosterone mean
testicular failure
250
what does high testosterone and low FSH and LH mean with azoospermia/small testes o/e
anabolic steroid use
251
tx male inferility
- mild- IU insemination
- Mod- IVF
- Severe- intracytoplasmic sperm injection
- Azoospermia- surgical sperm recovery/donor insemination
Surgery
- correction of epididymal block
- vasectomy reversal
- if hypogonadotrophic- hCG with or without rhFSH-- injections of hCG three times per week under the skin for at least six months and usually one to two years. monitor BP
- hyperprolactinaemia- bromocriptine (DA agonist)
- steroids- wait until effects are reverse
- smoking/alco cessation
* *- folic acid, Zn and vit e
- lose wt
252
tx of unexplained infertility
- dx of exclusion
- if trying for >2yrs- tx
- clomifene for female
- IVF
253
sx ix, tx prostate abscess
- frequent urination
- pain while urinating
- difficulty with urination, or retaining urine.
ultrasonography, cystoscopy to confirm the diagnosis.
abx- eg trimeth- and surgical drainage
254
most likely cell type of bladder cancer caused by schistosomiasis infection
Sq cell carcinoma
- transitional/urothelial cell carcinoma is most common cell type of bladder cancer, but schisto increases chance of SCC bladder cancer!
255
haematuria red flag for
bladder cancer, esp if painless
ddx
- prostatic adenocarcinoma
- UTI, cysitis, prostatitis
- stones
- BPH
- glomerulonephritis- Alport's, IgA post strep, HSP, goodpasture, SLE, membranoproliferative glomerulonephritis, IE
- renal tumour
- sickle cell
- trauma
256
what vaccine should be offered to all MSM, chronic liver disease pts, IVDU, haemophilia pts and close contacts
hep A
257
ddx of painless gential ulcer
- syphillis
| - lymphogranuloma venereum
258
ddx of painful genital ulcer
- herpes
- chancroid- Haemophilus ducreyi. painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy
- behcet's- eye sx (red, pain, blurring), swollen/painful/stiff joints
259
what is chancroid
Haemophilus ducreyi
- painful genital ulcer- sharply defined, ragged boarder
- painful inguinal node enlargement
260
what is curlings ulcer, sx
- stress induced ulcer of the duodenum/stomach
- GI bleeding- vomit, stool
- shock- tachy, hypotension
- burns victims, children, ICU pts
261
what should u co-prescribe with goserelin
Anti-androgen treatment such as cyproterone acetate/flutamide, due to the risk of tumour flare.
262
what is post obstructive diuresis
>200ml/hour following catheterisation
| - AKI, confusion, hyponatraemia
263
management of post obstructive diuresis
Patients producing >200ml/hr urine output should have around 50% of their urine output replaced with intravenous fluids to avoid any worsening AKI.
264
what two conditions are associated with pH >4.5
BV
Trich
- both have foul smelling discharge, altho trich is green
265
when should yuo refer men with a UTI to urology
- complicated- ie recurrent
| - ongoing sx despite abx
266
when do you tx UTI in catheterised pts
- dont tx if asymptomatic
| - 7d course if symptomatic
