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545 > Week 10: GU and gyne > Flashcards

Week 10: GU and gyne Flashcards

1
Q

what is the expected ages to achieve voluntary/intentional urination in kids?

A

girls: 5
boys: 6

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2
Q

what is the difference between primary and secondary enuresis?

A

primary: never achieved continence
secondary: incontinence after 3-6 months of dryness

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3
Q

polysymptomatic enuresis (urgency, frequency, dribbling) is associated with ________

A

constipation

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4
Q

what are risk factors for enuresis?

A
  • low SES
  • large family
  • single parent
  • low birth weight
  • OSA
  • short height
  • poor speech coordination
  • FAMILY HX
  • ADHD
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5
Q

organic causes of secondary enuresis?

A
  • UTI
  • DM
  • diabetes insipidus
  • nocturnal seizures
  • sickle cell anemia
  • medication
  • emotional stress
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6
Q

strategies to help with enuresis?

A
  • reward chart for dry nights in conjunction with other strategies
  • conditioning with alarms
  • dry bed training (parents wake them every hour, then stretch out the intervals)
  • bladder retention training (load with fluids, ask to hold for 5-10 min)
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7
Q

what is the difference between retentive and non-retentive encopresis?

A

retentive: fecal incontinence from functional constipation (liquid stool seeps around hard retained feces aka overflow)

non-retentive: no constipation/retention of stool

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8
Q

risk factors for encopresis?

A
  • males
  • family history
  • enuresis
  • ADHD
  • autism
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9
Q

what are some benefits associated with oral contraceptives?

A

○ prevention of pregnancy
○ protection against ovarian and endometrial cancers
○ decreased risk of functional ovarian cysts and benign breast conditions
○ improvement of acne
decreased menstrual blood loss and menstrual symptoms, such as dysmenorrhea

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10
Q

What are the two distinct time periods where it is normal to have physiologic vaginal discharge in pre-pubescent girls?

A
  • after birth (secondary to effects of maternal estrogen)

- 6 months 1 year before onset of menarche (around tanner stage 4)

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11
Q

history questions to ask with vaginitis in pre-pubescent girls?

A
  • colour, consistency, amount
  • duration
  • odour
  • itching
  • changes in bladder/bowel
  • urinary symptoms, abdo pain
  • changes in behaviour (nightmares, anxiety)
  • change in soap/detergents
  • bubble baths
  • recent illness
  • recent abx use
  • hygiene practices (wiping self, front to back etc)
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12
Q

DDX for vaginitis in pre-pubescent girls

A
  • irritant from soaps and detergents
  • irritant from tight fighting clothes
  • poor hygiene
  • pinworms
  • candida
  • STI
  • congenital abnormality
  • vulvar skin disease (lichen sclerosis, contact deramtitis, psoriasis, zinc)
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13
Q

if casts are present in hematuria, consider ______ origin of hematuria

A

casts = glomerular

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14
Q

common causes of hematuria without casts?

A 
• UTI 
	• Trauma 
	• Bleeding diathesis (hemophilia, ITP) 
	• Renal tumors 
	• Obstruction of the urinary tract 
	• Renal stones 
	• Hypercalciuria 
	• Hemolytic uremic syndrome 
Schistosomiasis (in endemic areas)
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15
Q

History for gross hematuria

A

trauma to trunk, abdo, or perineum

  • recent skin infection or pharyngitis
  • dysuria, abdo or flank pain
  • Presence at onset or end of voiding is urethral or bladder trigone
  • does child look puffy/edema?

FmHx: hematuria, kidney disease, hearing loss, SLE, bleeding diathesis, hemolytic anemia, or inborn error of muscle metabolism

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16
Q

workup if suspicion of glomerulonephritis (eg casts in urine micro)?

A

-ASO titre
-ANA
-C3
-CBC
-Bun, cr
-Alb
-
random urine for creatinine-protein ratio

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17
Q

how is microscopic hematuria defined?

A

3 or more UA with >6 RBC

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18
Q

Causes of microscopic hematuria?

  • infection
  • structural
  • trauma

-interstitial nephritis from….

A

infection: UTI, adenovirus, vaginitis, prostatitis

structure: renal vessel thrombosis, polycystic kidney, urinary obstruction, tumour
- hypercalciuria
- trauma
- interstitial nephritis from drugs

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19
Q

microalbuminuria in urine can be predictive of ________

A

glomerular nephritis

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20
Q

urine micro is best done when?

A

first morning sample

repeat 3 x

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21
Q

glomerulonephritis

most common causes?

A
  • acute post-strep
  • HSP
  • IgA nephropathy
  • SLE
  • hemolytic urea syndrome
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22
Q

what are some signs and symptoms associated with

  • post-strep glomerulonephritis?
  • HSP
  • HUS
A

post-strep:

  • gross hematuria
  • edema
  • HTN

HSP:

  • rash to lower extremities
  • abdo pain
  • proteinuria

HUS

  • bloody diarrhea
  • abdo pain
  • pallor
  • severe HTN
  • decreased urine output
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23
Q

UTI

causative organism for first infections?

other organisms?

A

E coli (80-90% first infections)

remainder are gram neg enteric bacilli (proteus, klebsiella, enterobacter)

gram positive cocci (enterococci, staph saprophyticus)

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24
Q

define difference between:

  • recurrent UTI
  • persistent UTI
  • relapse UTI
A

recurrent: reinfection with new organism (same or different species)

persistence: from med non-compliance or wrong abx
- when repeat urine cx remains positive after 14 days

relapse: symptoms recur within 2 months after initial episode even after negative cx was obtained at 14 days after abx completed (ie infection latent and flared)

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25
Q

how would you differentiate between cystitis and acute pyelo?

A

pyelo: urinary symptoms PLUS high fever, chills, flank pain, vomiting

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26
Q

AAP (2016) recommends that children younger than 2 years old should have ________ after first UTI

A

renal and bladder ultrasound

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27
Q

method of collecting urine specimen from:

  • young infant
  • older kiddo
A

infant: catheter (bag not reliable)

older kids: midstream

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28
Q

first line treatment of cystitis?

alternate?

A

-nitrofurantoin x 5 days
OR cefixime x 5 days

alternate:
Septra or amox-clav

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29
Q

first line treatment of pyelo?

A

cefixime x 7-10 days
OR
Septra for 7-10 days
OR Amox-Clav x 7-10 days

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30
Q

what is the most common benign breast tumour in pts <20?

A

fibroadenoma

31
Q

what is the first sign of puberty in females?

A

thelarche: breast bud beneath areola
- increase in estrogen (increase in fat)
- progesterone causes alveolar budding and lobular growth)

32
Q

what are some medications associated with galactorrhea?

A 
— Opiates
— Estrogens
— Digitalis
— Butyrophenones (haloperidol) — Phenothiazines
— Risperidone
— Metoclopramide
— Isoniazid
— Reserpine
— Cimetidine
— Benzodiazepines
— Tricyclic antidepressants
- illicit drugs: marijuana, heroin
33
Q

when do regular ovulatory menses usually start?

A

2-3 years after menarche

34
Q

thelarche occurs ______ years before menarche

Growth acceleration begins _____ years before thelarche

A

thelarche: 2-3 years before menarche
growth: 1 year before thelarche

35
Q

what is the difference between primary and secondary dysmenorrhea?

A

primary: absence of pelvic pathology

secondary: underlying pathology eg PID, endometriosis, cysts
* *endometriosis most common

36
Q

what hormone is involved in dysmenorrhea?

A

prostaglandins boooooooo

37
Q

how is primary amenorrhea defined?

A
  • no spontaneous menstruation in F of reproductive age
  • absence by age 15 if normal pubertal development
  • absence by age 13 with no secondary sexual development
  • absence of menarche within 1-2 years of full sexual maturation (SMR 5)
38
Q

Abnormal uterine bleeding

definition of:

  • prolonged bleeding
  • excessive bleeding
  • frequent bleeding
A

prolonged: >8 days
excessive: >6 pads/tampons per day
frequent: cycles under 21 days

39
Q

Secondary amenorrhea

  • definition
  • DDX
A

3+ consecutive months of amenorrhea

DDx:

  • pregnancy
  • systemic illness
  • weight change
  • stress
  • intense physical activity
  • eating disorder
  • meds
  • PCOS
40
Q

treatment of:

  • mild to moderate dysmenorrhea:
  • moderate to severe dysmenorrhea
A

mild to mod: OTC NSAIDs
-take 1-2 days before menses

mod to severe: naproxen as alternative

  • COCP with 30-35 estrogen for 3-4 months minimum
  • consider extended use
41
Q

treatment of:

abnormal uterine bleeding

A

monophasic COCP
PLUS
supplemental iron (ferrous gluconate preferred over sulfate)

42
Q

what dietary modification is recommended to improve PMS?

A

-calcium and vit D supplement

43
Q

Use of COCP for PMS?

A
  • conventional 21 day active 7 day placebo regime does not completely suppress ovulation –> often will exacerbate PMS during withdrawal week
  • lower estrogen (20 mcg), use of drospirenone (progestin) and extended use can reduce PMS
44
Q

varicocele

90% are located on ____ side

A

left

45
Q

surgical repair of hydrocele indicated if persisting beyond ______ (age)

A

one year old

46
Q

risk factors for neonatal hernia

A 
- Risk factors for neonatal hernia 
	○ Abdo wall defect 
	○ Ascites
	○ Connective tissue disease
	○ CF
	○ FmHx
	○ Low birth weight
	○ Mucopolysaccharidosis 
	○ Preterm birth (most significant risk factor)
	○ Undescended testis
Urologic malformations
47
Q

Testicular torsion
physical exam will show:

Torsion of appendix testis: physical exam will show:

A

testicular torsion
absent cremasteric reflex
scrotal erythema, edema, tenderness

appendix testis: blue dot sign, cremasteric reflex present
scrotal erythema, edema, NO tenderness

48
Q

positive Prehn’s sign is seen in:

A
  • orchitis
  • epididymitis
  • not a reliable sign in children**

relief of pain with elevation

49
Q

EPIDIDYMITIS

signs and symptoms

investigations

A
  • gradual onset pain
  • not common to have dysuria, frequency, discharge
  • hard to tell difference with torsion

cremasteric reflex PRESENT
scrotal erythema, edema, tenderness

Urinalysis: can be normal
urine culture often neg
STI testing

50
Q

ORCHITIS

signs and symptoms

possible causes

treatment

A
  • intermittent bilateral testicular pain
  • scrotal erythema, edema, tenderness
  • shiny overlying skin

viral: mumps, rubella, coxsackie, provirus

Supportive: rest, NSAIDs, ice packs

51
Q

Common organisms associated with balanitis

A

candida

gardnerella, staph, trich
HSV, HPV, syphilis, scabies(!), mycoplasma

52
Q

treatment of balanitis

A

retract foreskin
wash twice daily with warm salt water

if no improvement or is circumcised, treat empirically with clotrimazole BID x 1 week

53
Q

complication of SUBMUCOSAL fibroid?

A

infertility

interfere with embryo transfer and implantation

54
Q

most common symptoms of fibroids?

A 
menorrhagia
dyspareunia
bloating
pelvic pressure
urinary symptoms (urgency, frequency)
infertility
55
Q

treatment of fibroids?

A

definitive is surgical:

  • hysterectomy
  • myomectomy
GnRH agonist (leuprolide) shrinks fibroids temporarily, limit use to 6 months
COC, NSAIDs
56
Q

what are factors that LOWER risk of endometriosis?

A
  • higher parity
  • breastfeeding
  • exercise
  • long term omega 3 intake
57
Q

risk factors for endometriosis

A 
menarche before age 11
cycle length <27 days
heavy cycles
eating animal fat/trans fat
family hx in first degree relative
58
Q

endometriosis signs and symptoms

A

Progressive dysmenorrhea: does not respond to COC or NSAIDS
Deep dyspareunia (worse during menses)
Chronic pelvic pain
infertility
Ovarian mass
Sacral back ache w/menses
Painful defecation during menses (most predictable symptoms of deeply infiltrating endometriosis) + severe dyspareunia
GI/GU: perimenstrual tenesmus, diarrhea or constipation, dyschezia, dysuria, hematuria, nausea, distention, early satiety
Resp: thoracic endometriosis can present w/CP, pneumothorax, or hemothorax, hemoptysis, or scapular/neck pain
*can be asymptomatic

59
Q

first line treatment for endometriosis

A

definitive: TAH + BSO

COC and NSAIDs
Progestins (depo provera)
IUD

60
Q

vulvodynia

definition

A

persistent vulvar pain with no identifiable cause

present for at least 3 months

61
Q

mucopurulent cervicitis

signs and symptoms

A

often asymptomatic

cervical friability, copious discharge
need to r/o PID so swab for everything

62
Q

disseminated gonococcal infection

signs/symptoms

A

fever, arthritis, rash

63
Q

collect culture for gonorrhea along with NAAT in these situations

A
  • any obvious discharge (cervix, urethra, rectal)
  • suspected PID
  • treatment failure
  • sexual contacts outside of Canada
  • sexual assault
64
Q

gonorrhea test of cure

  • by culture: timeframe
  • by NAAT: timeframe
A

culture: 3-7 days after starting
- pharyngeal
- not typical treatment
- failure or resistance suspected
- uncertain compliance
- re-exposure
- pregnant
- PID/disseminated gonococcal infection

NAAT: 2-3 weeks after starting

65
Q

PID

what to assess during history

A

Review risk factors
LMP (lots of PID during first half of menstrual cycle)
Urinary symptoms suggestive of urethritis
Intramenstrual bleeding, dysmenorrhea, dyspareunia
Vaginal discharge
Abdominal or pelvic pain
RUQ if peri-hepatitis
Systemically unwell - fever, n/v, malaise (not always present)

66
Q

PID

3 DDX

investigations

A

ectopic pregnancy
appendicitis
ovarian torsion

swab for everything
CBC, CRP, full STI panel
u/a and cx if dysuria
PREG TEST

pelvic ultrasound

67
Q

Follow up of PID

  • time frame
  • if IUD in situ?
A

close f/u in 48-72 hours
-if no improvement –> send to ER for admission

IUD does not need to be removed unless no improvement 72 hours after abx

68
Q

Syphilis

  • transmission
  • symptoms
A
  • contact with syphilitic lesions
  • vertical transmission (congenital syphilis)

primary: painless indurated chancre, local lymphadenopathy

secondary: systemic (fever/chills, headache, malaise)
diffuse maculopapular reddish brown rash to palms and soles, condylomata lata, slopecia

early and late latent: no symptoms

69
Q

syphilitic genital lesions

also test for (ie rule out these DDX)

A
  • syphilis (NAAT)
  • chlamydia (NAAT)
  • HSV
70
Q

most common STI in US (according to Berk)

A

HPV

71
Q

HPV

risk factors

A
  • sex at young age
  • multiple partners
  • no condom use
  • concurrent STI
  • SMOKING
72
Q

SYPHILIS

complications in pregnancy?

complications in newborn?

A 
In pregnancy:
	• Miscarriage
	• Preterm birth
	• Low birth weight
	• Stillborn or death in neonate
In newborn with congenital syphilis:
	• Bony deformity
	• Severe anemia
	• Hepato and splenomegaly
	• Jaundice
	• CNS: blind, deaf, meningitis
rash
73
Q

HSV type specific serology is ordered for these conditions:

A

-pregnancy: if partner + for HSV (if negative, repeat at 32-34 weeks)

  • atypical/recurrent disease
  • serodiscordant couples
74
Q

PMDD premenstrual dysmorphic disorder

diagnostic criteria

A

mood (depressed, anxiety, labile, irritable) starting or stopping within few days of onset of period
-absent one week after period stops

  • impacts functioning
  • confirmed with daily ratings for minimum 2 consecutive symptomatic menstrual cycles

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