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Boards and Wards Complete > Urogenital complaints and Opthomology (320-331) (431-451) > Flashcards

Urogenital complaints and Opthomology (320-331) (431-451) Flashcards

1
Q

Under what 3 situations are UTIs most common?

A

Sexually active young women, elderly and posturethral catheter

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2
Q

Whats the most common causative bacteria

A

E.coli and gram negatives

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3
Q

main sx of uti?

A

dysuria

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4
Q

Main sx of pyelonephritis

A

back/flank pain

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5
Q

How to dx a UTI?

A

UA and reflex to culture - pyuria and + bacteria Gram stain

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6
Q

What follow up must be done on adolescents and men with pyelonephritis or recurrent infection?

A

Renal US and IVP to r/o anatomic etiology

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7
Q

How long does a pt with bacterial prostatitis need to be on antibiotics?

A

6-12 weeks for chronic

2 weeks for acute

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8
Q

What is the definition of asx bacteriuria

A

Urine culture >100,000 colony forming units

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9
Q

What patient populations should you treat asx bacteriuria?

A
  1. pregnant women
  2. pts with renal transplant
  3. about to undergo genitourinary procedure
  4. severe vesicouretral reflux
  5. struvite calculi
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10
Q

What is most common mode of transmission of AIDS worldwide?in USA?

A

heterosexual worldwide

homosexual USA

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11
Q

What genetic mutation makes pts highly resistant to HIV transmission?

A

CCR5 homozygous deletion

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12
Q

At what CD4 copunt do opportunic infections usually arise?

A
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13
Q

What should pts be put on when CD4

A

TMP-SMX to prophylax against PCP and toxoplasma encephalitis

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14
Q

Pt with painful vesicular and ulcerated lesions that resolve over 7 days. How to confirm dx?

A

direct flourescent antigen (DFA) staining. Tzank prep, serology, HSV, PCR, or culture

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15
Q

Risk of _____ increases 7-10x in women with hx of salpingitis

A

ectopic pregnancy

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16
Q

What antibiotics should be used on pts with PID?

A

azithromycin
flouroquinilone + metronidazole
cephalosporin + doxy

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17
Q

Pt presents with painless papule that erodes into a painless ulcer accompanied by tender, swollen lymph nodes causing groove in the inguinal ligament (groove sign) Dx? Etiology?

A

Lymphogranuloma venereum (serovars L1-L3) Chlamidya trachomatis

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18
Q

Pt from underdeveloped country presents w painful ulcer accompanied by painful swollen lymph nodes which suppurate and cause destructive changes in the groin. Dx? Etiology? Tx?

A

Chancroid
Haemophilus ducreyi
Macrolide, doxycycline and cephalosporin

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19
Q

Pt from underdeveloped country presents with painless nodules which over time slough off exposing large ulcers which spread and cause extensive destructive changes in the groin.

Biopsy shows purple oval forms inside macrophages which strain purple with Wright stain. Dx? Tx?

A

Granuloma inguinale (Donovaniasis)

Tx: Macrolide or doxy

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20
Q

What prophylaxis should pts receive if CD4

A

azithromycin for Mycobacterium avium intracellulare complex (MAC)

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21
Q

When should HAART therapy be started? (3 active antiviral agents)

A

If pt’s have symptoms related to HIV infection or if pt’s CD4

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22
Q

Painless hematuria DDx?

A

Primary renal disease (tumor, glomerulonephritis)
bladder tumor
prostatic dz

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23
Q

Painful hematuria DDx?

A

nephrolithiasis, renal infarction, UTI

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24
Q

What is the term when hemoglobin is detected in UA but theres no RBCs on microanalysis?

A

myoglobinuria or hemoglobinuria

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25
Q

When should you do cystoscopy?

A

only after UA and IVP

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26
Q

After what age is BPH common

A

> 45, 90% men older than 70 have BPH

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27
Q

What are the 3 criteria of BPH?

A

prostate size > 30mL

maximmum urinary flow rate 50

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28
Q

When is TURP indicated?

A

Refractory disease

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29
Q

For prostate glands >75g, what is the reccomendation?

A

Open prostatectomy

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30
Q

Pt presents with fevers, chills, low back pain, urinary frequency, and urgency, tender possible fluctuant and swollen prostate,.
Labs show leukocytosis, pyruia and bacteriuria.
Dx? Tx?

A

Prostatitis, dx made clinically

Tx: fluoroquinolone or TMP-SMX

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31
Q

What is the most common ca in males and second most common cause of ca death?

A

prostate cancer. First MCC death is lung ca

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32
Q

PSA sensitive or specific?

A

sensitive. PSA is elevated in 90% of prostate adeno CA but, controversy over screening tool

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33
Q

Where does prostate ca often metastasize?

A

via lymph/ blood causing osteoblastic lesions

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34
Q

What is the primary cause of impotence

A 
erectile dysfunction
due to...
psychological
decreaased testosterone
hypo/hyperthyroid
Cushings syndrome 
Increased prolactin
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35
Q

What are some causes for secondary erectile dysfunction

A

vascular dz
Drugs
Neurologic dz

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36
Q

**How can you differentiate psychogenic from organic causes of erectile dysfunction

A

nocturnal penile tumescence

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37
Q

What is the mechanism of action of Sildenafil, tadalafil, Vardenafil etc?

A

Cyclic GMP-specific PDE5 inhibitor which improves relaxation of smooth muscles in corpora cavernosum

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38
Q

What is an absolute contraindication to PDE5 inhibitors?

A

Use of nitrates

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39
Q

Decreased vision secondary to fafilure of development of the pathway between the retina and visual cortex before ages 7-11

A

ambylopia

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40
Q

What sx might a person with ambylopia have

A

Esotropia (inward rotation of eyes)
exotropia ( outwardly rotated walled eyes)
Refractive error not correctable with lenses

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41
Q

Unable to see in bilateral temporal fields usually caused by a pituitary tumor

A

bitemporal hemianopsia

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42
Q

Lesion of the medial longitudinnal fasciculus classically found in multiple sclerosis

A

internuclear opthalmoplegia

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43
Q

What is the defecit caused by internuclear opthalmoplegia?Why?

A

inability to adduct the ipsilateral eye past midline on lateral conjugate gaze

lack of communication between the contralateral cn Vi nucleus and ipsilateral CNIII nucleus

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44
Q

Midbrain tectum lesion that results in paralysis of upward gaze and is associated with pineal tumor

A

Parinaud’s syndrome

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45
Q

Afferent defect of cn ii causing pupil not to react to direct light, but will react consensually when light is shined into contralateral eye

A

Marcus Gunn Pupil

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46
Q

How to test marcus gun pupil?

A

swinging flashlight test - denervated eye will appear to dilate when light is shone in because it is dilating back to baseline when consensual light is removed from other eye

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47
Q

pathognomonic for tertiary syphilis (neurosyphilis

A

Argyll Robertson pupil (pupils constrict with accomodation but do not constrict to direct light stimulation)

48
Q

upward lens dislocation

A

Marfans

49
Q

downward lens dislocation

A

homocystinuria

50
Q

variable lens dislocation

A

Alport’s syndrome

51
Q

Ring of golden pigment around the iris

A

Kayser Fleisher Ring

52
Q

Fleshy growth from conjunctiva onto nasal side of cornea associated with exposure to wind, sand, sun, dust etc

A

Pteryguim

53
Q

Benign yellowish nodules on either side of the cornea seen in pts >35, may have foreign body sensation in eye

A

Pinguecula

54
Q

Spontaneous onset of a painless right red patch on the sclera - benign self limited condition usually seen after over exertion

A

Subconjunctivial hemorrhage

55
Q

If you see subconjunctival hemorrhage in setting of trauma, what must be done?

A

r/o ruptured globe

56
Q

Rapid loss of vision and pain upon mocing the eye, spontaneously remitting in 2-8 weeks, but each relapse damages more of the eye. Caused by inflammation of the optic nerve, usually unilateral.+APD. Dx? Tx? What is the first sign of?

A

Retrobulbar neuritis
tx - corticcosteroids
1st sign of multiple sclerosis

57
Q

Inflammation of the optic nerve within the eye, can be caused by infection, meningitis, syphillis, tumor. variable vision loss and decreased pupillary light reflex. +Affarent pupillary defect if unilateral. Dx? Tx?

A

optic neuritis

Tx corticosteroids

58
Q

What does the fundoscopic exam look like in pt with optic neuritis?

A

disk hyperemia

59
Q

Inflammation of the internal meiobomian sebaceous gland that presents with swelling on conjunctival surface of eyelid. Dx? Tx?

A

Chalazion

tx: warm compress/steroid ointment

60
Q

Infection of the external sebaceous glands of Zeiss or Mol that presents with tender red swelling at lid margin. Dx? tx?

A

Hordeolum (stye)

Tx: hot compress add antibiotics

61
Q

Inflammation of the eyelids and eyelashes resulting from infection ususally S. aureus, or secondary to seborrhea. Presents as red, swollen eyelid margins with dry flakes noted on eyelashes. Dx? Tx?

A

Blepharitis.

Tx: Wash lid margins daily with baby shampoo control scalp seborrhea with shampoo

62
Q

Marked swelling and erythema of the eye often with proptosis, decreased vision, limited eye movement. Can spread to cavernous sinus leading to thrombosis and meningitis. Dx? Tx?

A

Oribital cellulitis

Tx emergently with IV vancomycin, + 3rd gen cephalosporin, CT scan to r/o abscess

63
Q

How do you differentiate pre septal and oribital cellulitis?

A

Pre-septal cellulitis will not have changes in vision or limited eye moment.

64
Q

Infection of the lacrimal sac, usually caused by S.aureus, s. pneumo, h. influe, or s. pyogenes

A

Dacryocystitis

65
Q

What is the differential Dx for Red eye?

A 
Bacterial conjunctivitis
Viral conjunctivitis
Allergic conjunctivitis
Hyphema
Xerophthalmia
Corneal abrasion 
Keratitis
Uveitis
Angle closure glaucoma
Subconjunctival hemorrhage
66
Q

Pt with minimal pain, no vision changes, has red eye
PURULENT discharge, no pupillary changes
RaRELY pre-auricular adenopathy (only N.gono)Dx? Tx?

A

Bacterial conjunctivitis

Topical flouroquinolone or erythromycin

67
Q 
Pt with minimal pain, no vision changes, red eye
WATERY discharge, no pupillary changes 
Often pre-auricular adenopathy
Often pharyngitis
Dx? causes? Tx?
A

viral conjunctivitis
Causes: adnovirus, HSV, EBC, influenza, echovirus, coxsackie
Tx: None required,self-limited

68
Q

No pain, vision, or pupil changes. red eye
marked pruritis
Bilaterla WaTERY eyes
dx? Tx?

A

Allergic conjunctivitis

Antihistamine or steroid drops

69
Q

Blood in anterior chamber of the eye, fluid level noted. Pain, no vision changes, red eye noted,
No discharge, no pupil changes Dx? Cause? Tx?

A

Hyphema
caused by blunt ocular trauma
Tx: check intraocular pressure

70
Q

Minimal pain, vision blurry, no pupillary changes no discharge. Bitot’s spots and keratoconjunctivitis sicca seen. dx? causes? tx?

A

Xerophthalmia
Causes: Sjogren’s dz or vitamin a defeciency
Tx artificial tears, vitamin A

71
Q

What are bitot spots?

A

desquamated conjunctival cells seen in Xerophthalmia

72
Q

How do you diagnose Keratoconjunctivitis sicca seen in Sjrogen’s?

A

Schirmer test - place filter paper over eyelid and if not wet in 15 mins, Dx.

73
Q

Painful, with photophobia red eye.

No puil changes, watery discharge. flourescein stain shows corneal defect…dx? Tx?

A

Corneal abrasion
Caused by direct trauma to eye
Tx: antibiotics, eye back, examine daily

74
Q

Pain, photophobia, tearing DeCREASED VIsiOn.

Flourescein stain shows dendritic branching. Pus in anterior chamber (hypopyon - grave sign). Dx? Cause? Tx

A

Keratitis
caused by Herpes simplex , but can be caused by adenovirus, HsV, pseudomonas, s. pneumo, staph, moraxella.
Tx: emergency immediate opthalmology consult and topical vidarabine

75
Q

Inflammation of the iris, ciliary body, and/or choroid
Pain, miosis, photophobia
Flare and cells seen on aqueous humor on slit lamp examination. Dx? Causes? Tx?

A

Uveitis
Seen in seronegative spondyloarthropathy, IBD, sarcoidosis or infection (cmv, syphillis, TB)
Tx: underlying disease

76
Q

Severe eye pain, red eye, decreased vision, halos around lights, fixed mid-dilated pupil, eyeball firm to pressure and vomiting. Dx? Cause? Tx?

A

Acute closure glaucoma
decreased aqueous humor outflow via canal of Schlemm - mydriatics can also cause
Tx: EMERGENCY - IV mannitol and glaucoma acetazolamide, laser iridotomy, timolol bromonidine

77
Q

Spontaneous onset of painless bright red patch caused by rupture of episcleral vessel. Dx? Cause? Tx?

A

Subconjunctival hemorrhage
overexertion, valsalva, or trauma Can also be seen in pts with uncontrolled HTN
Tx: self limited, check blood pressure

78
Q

Yellow eye (icterus) caused by

A

bilirubin staining the sclera

79
Q

yellow vision seen in what drug toxicity?

A

digoxin

80
Q

Blue vision due to what drug use?

A

Viagra

81
Q

Blue sclera seen in what 2 dz?

A

Osteogenesis imperfecta
OR
Marfans

82
Q

Opaque Eye DDx

A 
Cataracts
Tumor
Glaucoma
congenital
Diabetes- sorbital precipitation
Hurler's disease
83
Q

If child has opaque eye, what to r/o?

A

Retinoblastoma

84
Q

Defect in iduronidase causing multiorgan mucopolysaccaride accumulation, dwarfism, hepatosplenomegaly, corenal clouding, progressive mental retardation, death by age 10

A

Hurler’s disease

85
Q

How long after diabetes does retinopathy occur?

A

about 10 years

86
Q

What is the best predictor of diabetic retinopathy?

A

direct correlation of A1c

87
Q

What are the 2 types diabetic retinopathy?

A

Background type

Proliferative type

88
Q

What does the retina look like in background type retinopathy? tx?

A

Flame hemorrhages, microaneurysms and hard/soft exudates (cotton-wool spots) on retina
tx: strict glucose and HTN control

89
Q

What does the retina look like in proliferative type diabetic retinopathy? tx?

A

More advanced dz, with neovascularization easily visible around the fundus (hyperemia) and hard exudates.
Tx: photocoagulation (laser ablation of blood vessels in the retinal) which slows the progression but is not curative.

90
Q

Painless loss of visual acuity and presents with altered pigmentation in the macula. Pt retains peripheral vision. Dx? tx?

A

Age related macular degeneration

antioxidants, and anti-VEGF

91
Q

Presents with painless dark vitreous floaters, flashes of light (photopsias), blurry vision, eventually progressing to a cutain of blindness as it worsens. dx? Tx?

A

Retinal detachment

Tx urgent opthamology consult

92
Q

Slowly progressive defect in night vision (often starts in young children) with ring shaped scotoma (blind spot) that gradually increases in size to obscure more vision. Dx? Cause? What syndrome is this part of? Tx?

A

Retinitis Pigmentosa
Hereditary, not clcear
part of Laurence-Moon-Biedl syndrome
No Tx

93
Q

Absent red reflex, actually appears white seen in retinoblastoma

A

Leukocoria

94
Q

small hemorrhagic spots with central clearing associated with endocarditis

A

Roth Spots

95
Q

Copper wiring, flame hemorrhages, AV nicking seen in what?

A

subacute HTN and/or arthrosclerosis

96
Q

_______ appears as disk hyperemia, blurring, and elevation. associated with increased intracranial pressure

A

Papilledema

97
Q

________ neovascularization seen in sickle cell anemia

A

Sea Fan

98
Q

______ Seen on retina during retinal detachment

A

Wrinkles

99
Q

_________ seen on macula seen in Tay Sachs, Niemann pick dz and central renal artery occlusion

A

Cherry red spot macula

100
Q

Yellow cholesterol emboli in retinal artery

A

Hollenhorst plaque

101
Q

Brown raised macule on the retina

A

Malignant melanoma (MC intraocular tumor in adults)

102
Q

Read about glaucoma p 444

A

open vs closed glaucoma?

103
Q

What is the most common adult orbital tumor?

A

cavernous hemangioma - large well circumscribed vascular tumor (proptosis of the eye)

104
Q

From where do most of the metastases to the oribit come from?

A

breast, lung, prostate

105
Q

What kind of orbital tumors show a spectrum from benign reactive lymphoid hyperplasia to lymphoma in older pts?

A

Lymphoid tumors

106
Q

Mesenchymal orbital tumor

A

fibrous hystiocytoma

107
Q

cystic mass of sinuses caused by duct obstruction, frontal and ethmoid sinuses most commonly involves.

A

Mucocele

108
Q

Bony tumor -orbital

A

fiberous dysplasia

109
Q

Tumor of the peripheral nerve seen in neurofibromatosis

A

schwannoma

110
Q

what’s the most common orbital tumor in children (vascular)? Dx? tx?

A

capillary hemangioma

tx: beta blockers

111
Q

benign cystic mass with connective tissue and skin appendages (hair, sebaceous glands)

A

Dermoid cyst

112
Q

What is the most common orbital malignancy in children?

A

rhabdomyosarcoma

113
Q

tumor of early childhood with large lymph channels, often have hemorrhage

A

lymphangioma

114
Q

Most common metastatic tumor in children, ecchymosis with proptosis

A

neuroblastoma

115
Q

what is the gold standard for imaging orbit esp for foreign body?

A

CT scan, never MRI bc magnet might move object if it’s metallic.

116
Q

Review p 448- 451

A

eye-related trauma and opthalmic medications

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