Urological/STD/Men and Women's Health Flashcards
Most common UTI bacteria
e. coli, p mirabilis, k pneumoniae, enterobacter, s. saprophyticus
Midstream bacterial count for UTI
100,000 organisms
Nitrites indicate what type of bacteria in sample?
Usually gram - nitrate producers
Hyaline cast
most common, low urine flow, dehydration, vigorous exercise
Type of cast - crystals
No clinical significance
Type of cast - RBC
Always pathological, consider glomeruloneephritis, urinary tract injury
Type of cast - WBC
Consider inflammation or infection such as pyelonephritis. Not a UTI
Type of cast - epithelial
Acute tubular necrosis (poisoinng), hepatitis
How long tx an uncomplicated UTI
3 days
What should you always do before tx pylonephritis?
Get a culture
Kegal exercises - How many?
3 sets of 8-12 3-4 times weekly for 15-20 weeks
Hallmark finding on urolithiasis (stone formation)
Severe pain waxes and wanes, may radiate to groin, testicles, suprapubic area, and labia
What is the gold standard for dx of urolithiasis?
Helical CT
Dx HIV
Establish dx with EIA or ELISA, confirmed with Western Blot
What live vaccines should you never give with HIV?
shingles, chicken pox, MMR
Lab testing with HIV
CD4 counts and viral load at dx and every 3-4 months, screen for Hep A, B, C. Glucose and lipid panel, STD assessment
When is HIV considered AIDS?
CD4 count less than 200
Bacterial vaginosis
Polymicrobial clinical syndrome resulting from replacement of natural flora with high concentrations of anaerobic bacteria
Hallmark sx of bacterial vaginosis?
Profuse grayish-white malodorous vaginal discharge
Gold standard for dx of bacterial vaginosis
gram stain absence or decreased lactobacilli
Treatment of bacterial vaginosis
metronidazole 500mg BID 7 days
Chlamydia associated with
PID, infertility, ectopic pregnancy
What age is Chlamydia most common in?
under 25 years old
Sx Chlamydia
often asymptomatic, mucopurulent cervicitis, friable cervix with pain on movement
What is important to do with dx of Chlamydia?
Retest in 3 months
Dx studies Chlamydia
NAAT with urine or vaginal swabs, DNA probe, culture
Tx Chlamydia
Doxycycline 100mg BID 7 days OR azithromycin 1 gram once
Gonorrhea sx in males
purulent urethral discharge, dysuria, testicular pain, or no symptoms
Gonorrhea sx in females
Often asymptomatic, endocervical discharge, dysuria, bartholins gland abcess
Dx studies in Gonorrhea
Gram stain of exudate, DNA probe, culture
Tx Gonorrhea
Ceftriaxone 250mg AND azithromycin 1gram OR doxycyline for 7 days
Trichomoniasis sx in females
Asymptomatic, discharge that is frothy, diffuse, and yellow green in color, cervical petichiae (strawberry cervix)
Trichomoniasis sx in males
asymptomatic, urithral discharge, dysuria, epididymitis, prostitis
Dx studies for Trichomoniasis
Wet prep with flagilated motile cells, pH >4.5, POC test for women, PCR testing for men
Tx Trichomoniasis
Metronidazole 2 grams single dose or Tinidazole 2 grams single dose
Syphilis - Primary stage
Chancre at site of inoculation. Painless. 1-5 weeks then heals. Regional lymphadonopathy
Syphilis - Secondray
Rash that is bilat symmetrical polymorphic, and not itchy. Soles and palms. 2-6 weeks then resolves.
Condyloma lata
Secondary Syphilis sign. Pink peripheral warty lesions on genitals.
Syphilis - Latent
Asymptomatic
Syphilis - Tertiary
Cardiovascular - aortic valve disease and aneurisms
Neurological - meningitis, encephalitis, tabes dorsalis, dementia
Integumentary - Gummas
Orthopedic - Charcot joints, osteomylitis
Tx Syphilis
Benzathine PCN G IM
Doxycycline or tetracycline or erythromycin if PCN allergic
HPV vaccine recommended at age?
11-12
Age of initial cervical screening
Start age 21, screening at time of initial intercourse if < 21 yo ad HIV present or immunocommprimised post organ transplant
Age to stop cervical screening
65 who have had adequate recent screening = 3 neg screening PAPS and 2 neg HPV/PAP co-tests within 10 years of stopping with at least one being in the last 5 years
PAP screening
21-29 - every 3 years with cytology
> 30 every 5 years with cytology and HPV
Ex HIV, immunosuppression, every 6 months X2 then annually
PAP after hysterectomy
benign disease - D/C
NON Benign - 3 annual neg tests ACS 20 years ACOG
When do you refer with abnormal pap
LSIL, HSIL (CIN, CIN 1, CIN 2, CIN 3)
PH with candidiasis (vaginal)
4.0 - 4.5
When should you get an ultrasound with breast mass?
Pregnancy and < 30
What finding suggests BPH?
Firm, smooth, symmetrically enlarged prostate
Wat exam finding suggests bacterial prostititis?
Enlarged, boggy, and tender prostate
What are risk factors for prostate cancer?
Older age
African American
Family hx of relative <65
BRCA1 or 2 genes
Sx prostate ca
asymptomatic, prostate feels hard, nodular on exam
Prostate screening according to ACS
Average risk starting age 50, high risk 40-45
Initial PSA >2.5 screen annually, PSA < 2.5, every 2 years. PSA >4 refer
What is common with epididymitis?
Prolonged sitting. Think truck driver.
Prims sign
discomfort lessens with elevation of testes - epididymitis
Risk factor - testicular cancer
Hx of cryptorchidism - Higher if uncorrected
Testicular atropy
Klinfelter’s syndrome
