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PNCB CPNP-PC > GU/GYN > Flashcards

GU/GYN Flashcards

1
Q

Enuresis

Def: -1- that occurs -2- when -3- should be present

A
  1. Involuntary urination
  2. at an age
  3. voluntary control
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2
Q

Enuresis - Types
> Primary: has -1- for -2-
> Secondary: -3- months and -4-

A
  1. been dry
  2. < 6 months
  3. Dry for 6+
  4. begins to wet again
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3
Q

Enuresis - Types
> Functional urinary -3-: -1- (formerly called -2-)
> Nocturnal enuresis: -3- during -4-

A
  1. daytime wetting
  2. diurnal enuresis
  3. incontinence
  4. sleep
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4
Q

Enuresis - Incidence
> -1-: Up to -2-
> -3-: Up to -4-
> Most -5-

A
  1. 3yo
  2. 40%
  3. 7 yo
  4. 10%
  5. cases are functional
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5
Q

Enuresis - S/S
> Hx of -1-
> Assess for -2- (e.g., -3-, -4-, -5-)

A
  1. bed incontinence
  2. comorbidities
  3. constipation
  4. sleep apnea
  5. ADHD
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6
Q

Enuresis - Lab/Dx
> -1- (-2-, -3-)
> -4-

A
  1. UA
  2. assessing for UTI
  3. or DM
  4. ultrasound (masses)
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7
Q

Enuresis - Mgmt
> Psychobehavioral
» -1- (-2-), positive reinforcement such as sticker chart
» -3- (-4-) (geared toward training the bladder to hold more urine)

A
  1. enuresis alarm
  2. moisture sensor
  3. bladder control training
  4. watch timer
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8
Q

Enuresis - Mgmt
» Meds
»> -1- 25 mg qhs x 1wk
»> Desmopressin: available -2-, intranasally, no -3-
»> Oxybutinin (ditropan): for detrusor muscle hyperactivity assoc w/ -4- in children < 6 yo; 5 mg may be given BID, max 5 mg TID

A
  1. Imipramine
  2. orally
  3. need for consistency
  4. neuro disorders (spina bifida)
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9
Q

Enuresis - Mgmt
» -1-
»> Imipramine 25 mg qhs x 1wk
»> -2-: available orally, -3-, no need for consistency
»> -4-: for detrusor muslce hyperactivity assoc w/ neuro disorders (spina bifida) in children < 6 yo; 5 mg may be given BID, max 5 mg TID

A
  1. Meds
  2. Desmopressin
  3. intranasally
  4. Oxybutinin (ditropan)
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10
Q 
Enuresis - Mgmt
> Non-pharm
>> -1- (better success rate than med use), -2-
>> -3- (-4-)
> -5-, if indicated
A
  1. Hypnosis/self-hypnosis
  2. done in voiding clinics
  3. Parental education
  4. “emphasis on ‘involuntary’”
  5. Treat UTI
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11
Q

Urinary Tract Infection
Def: -1- and inflammation of the -2- are more common in males (uncircumcised) in the first year of life. -3- increases at -4- throughout the lifespan.

A
  1. Bacterial infections
  2. urinary tract
  3. Incidence in females
  4. a 10:1 ratio
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12
Q

Urinary Tract Infection
Def: Bacterial infections and -1- of the urinary tract are more common in -2- in the -3-. Increases are seen in females at a 10:1 ratio -4-.

A
  1. inflammation
  2. males (uncircumcised)
  3. first year of life
  4. throughout the lifespan
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13
Q

Urinary Tract Infection - Causes/Incidence
> Both -1- UTIs in -2- are typically caused by the folowing organisms:
» -3-: Approximately -4- of cases
» -5-

A
  1. Male and female
  2. childhood
  3. E. coli
  4. 85%
  5. Staph aureus
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14
Q

Urinary Tract Infection - Causes/Incidence
> Predisoposing factors include urinary stasis, -1- or -2-, and non-obstructive causes (e.g. -3-, poor hygiene, -4-, and coitus)

A
  1. congeintal
  2. acquired obstructive lesions
  3. neurogenic bladder
  4. constipation
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15
Q

Urinary Tract Infection - Causes/Incidence

> -1- (-2-) may result in -3-, eventual HTN, and renal failure

A
  1. High-grade vesicoureteral reflux
  2. caused by repeated or poor catheterization
  3. renal scarring
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16
Q

Urinary Tract Infection - S/S
> Infants
» May have no -1- (-2- on -3- for -4-)

A
  1. signs or symptoms
  2. UTI
  3. DDx
  4. Fever
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17
Q 
Urinary Tract Infection - S/S
> Children/adolescents:
>> -1-
>> -2-
>> Suprapubic/lower -3-
>> -4-
>> -5-
A
  1. Dysuria
  2. frequency
  3. abdominal discomfort
  4. fever
  5. hematuria
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18
Q

Urinary Tract Infection - Lab/Dx
> -1- for culture/sensitivity indcated for those who -2- (-3- may be used for mild symptoms or follow-up)
> UA: -4- (-5-)

A
  1. Straight cath
  2. cannot voluntarily void
  3. clean catch
  4. Leukocytes, erythrocytes, nitrites
  5. nitrites: septic urine
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19
Q

Urinary Tract Infection - Lab/Dx
> Leukocytosis in the -1-
> -2- undergo -3- US

A
  1. CBC
  2. Febrile infants should
  3. renal and bladder
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20
Q 
Urinary Tract Infection - Mgmt
> -1- for -2-
>> -3- or 
>> -4-
>> Then -5-
A
  1. PO abx
  2. 1-2 weeks
  3. Start with cephalosporins
  4. amoxicillin/clavulanate
  5. change re:UC results
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21
Q

Urinary Tract Infection - Mgmt
> -1- in -2-; change the antibiotic if no improvement seen
> -1- in 7-10 days, then every 1-3 months for 1 year
*Note: Children -3- with a -4- should be -5- abx

A
  1. Follow up
  2. 2-3 days
  3. < 2 mo
  4. UTI
  5. hospitalized for parenteral
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22
Q

Urinary Tract Infection - Mgmt
> Renal -1- after first UTI:
» -2-
» -3-

A
  1. US
  2. febrile infants
  3. all children 2-24 mo
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23
Q

Urinary Tract Infection - Mgmt
> -1- is indicated if -2-
> -3- is not indicated

A
  1. VCUG
  2. US is patho
  3. Antimicrobial prophylaxis
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24
Q

Hypospadias
Def: one of the most common -1- in which the -2- is not located -3- of -4-

Causes/Incidence
> The -5-; currently hypothesized to be deformity rather than a malformation

A
  1. congenital birth defects
  2. eurethral opening
  3. at the tip
  4. the penis
  5. etiology is unclear
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25
Q

Hypospadias - Causes/Incidence
> Occurs in -1-; often -2-
> Likelihood of -3- such as -4-, inguinal -5- is noted

A
  1. 1:200 live births
  2. familial
  3. other GU anomalies
  4. undescended testicles
  5. hernia or hydrocele
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26
Q

Hypospadias - Types
> -1-: opening -2- of the penis
> -3-: opening along the shaft of the penis
> -4-: opening located where the -5- meet

A
  1. Subcoronal
  2. near the head
  3. Midshaft
  4. Penoscrotal
  5. penis and scrotum
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27
Q

Hypospadias - S/S
> Urinary stream that -1-
> -2- (-3- of the penis)
> -4- (about 10% of cases)

A
  1. isn’t straight
  2. Chordee
  3. ventral bowing
  4. undescended testicle
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28
Q

Hypospadias - Lab/Dx

> Diagnosis is made by…

A

…clinical findings

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29
Q

Hypospadias - Mgmt
> -1- at birth
> -2- may be contraversial (-3- may be -4-)
> Surgery best done around -5-

A
  1. Referral to urologist
  2. Circumcision at birth
  3. foreskin
  4. used in repair
  5. 3-18 months of age
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30
Q

Hydrocele
Def: -1- in the sheath that -2-; common in premature males

Causes/Incidence
> Found in -3- of male newborns

A
  1. fluid collection
  2. surrounds the testicles
  3. 80-90%
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31
Q

Hydrocele - Causes/Incidence
> Risk factors
» Newborn: -1-, -2-, crytpoorchidism, hypospadias, -3-

A
  1. LBW
  2. preterm birth
  3. CF
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32
Q 
Hydrocele - Causes/Incidence
> Risk factors
>> Older children/adolescents
>>> -2-
>>> -3-
>>>> epididymitis
>>>> -4-
>>>> -5-
A
  1. Idiopathic
  2. secondary
  3. orchitis
  4. testicular torsion/trauma
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33
Q

Hydrocele - Types
> -1-: -2-
> -3-: -4- to the -5-

A
  1. Noncommunicating
  2. sealed
  3. communicating
  4. open
  5. abdomen (hernia is likely)
34
Q

Hydrocele

Signs/Symptoms
> One or both -1- (-2-)

Labs/Dx
> Usually diagnosed on -3-
> -4-

A
  1. testicles are swollen
  2. light test: transluscent
  3. physical exam
  4. US
35
Q

Hydrocele - Mgmt/Tx
> Referral -1-
> -2-: usually -3-
> -4-: may -5-

A
  1. to pediatric urologist
  2. noncommunicating
  3. resolves spontaneously 1 yr
  4. Communicating
  5. require surgery (hydorcelectomy)
36
Q

Cryptorchidism

Def: -1- of the testes from the -2- due to failure to descend form the abdomen in utero; referred to as a(n) -3- (-4-)

A
  1. absence of one or both
  2. scrotal sac
  3. undescended testicle
  4. vs. a retractile
37
Q

Cryptorchidism

S/S
> Inability -1-
> Often -2-

Lab/Dx
> usually diagnosed on -3-

A
  1. to palpate testicle
  2. no symptoms
  3. physical exam
38
Q

Cryptorchidism - Mgmt
> If undescended, refer to -1- by -2-
> Testicular self-exam (TSE) for -3- probability

A
  1. peds urologist
  2. 4-6 months of age
  3. increased testicular cancer
39
Q

Testicular Cancer
Def: -1-; most common solid malignancy in men 20-35

Causes/Incidence
> -2-
> Peak incidence b/t -3-; begin Testicular self-exam (TSE) screenings at age 15

A
  1. malignancy of the testicles
  2. Lifetime risk: 1:250
  3. 15 & 35 yo
40
Q 
Testicular Cancer - Causes/Incidence
> Most common in -1-; black males have -2-, but -3-
> Risk factors:
>> -4- with testicular cancer
>> -5-
A
  1. White males
  2. lower rates
  3. higher risk of death
  4. first-degree relative
  5. crytporchidism
41
Q

Testicular Cancer - Risk factors
> Congenital
» -1-
» -2- (e.g., -3-)

A
  1. Hypospadias
  2. Chromosomal disorder
  3. Klinefelter
42
Q

Testicular Cancer - S/S
> Testicle may become -1-
> -2- in the -3- or scrotum
> -4- (5% of patients with -5-)

A
  1. Swollen or grow
  2. Heaviness/aching
  3. abdomen
  4. genetic disorder
  5. Klinefelter syndrome
43
Q

Testicular Cancer

Lab/Workup
> Initially, -1- to distinguish mass from testes

Tx/Mgmt
> refer to -2-
> Mgmt includes -3- and sometimes -4-

A
  1. US
  2. peds/urology
  3. surgery
  4. chemo/radiation
44
Q

Testicular Torsion

Def: -1- adn strangulation of the -2- causing acute pain; constitutes a(n) -3- to prevent a(n) -4- and infertility

A
  1. Twisting
  2. spermatic cord
  3. surgical emergency
  4. necrotic testicle
45
Q

Testicular Torsion

Causes/Incidence
> Occurs most often between -1-
> -2- produces acute pain

S/S
> -3- in one testicle not caused by -4-

A
  1. 12-18 years
  2. interruption of the vascular flow
  3. Sudden severe pain
  4. injury or accident
46
Q

Testicular Torsion - S/S
> -1- on -2- of the testicle
> -3- in the testicle

A
  1. swelling
  2. one side
  3. visible lump
47
Q

Testicular Torsion - S/S

> -1- (-2- resulting in -3- on the same side)

A
  1. Absent cremasteric reflex
  2. stroking of the inner thigh
  3. retraction of testicle
48
Q

Testicular Torsion

Lab/Dx
> Phys Ex, -1-, medical history
> Scrotal -2- to determine presence of blood flow within the teseticular tissue may be ordered

Mgmt
> Refer for -3-
> If not treated -4-, the testicle -5-

A
  1. description of symptoms
  2. US w/ doppler signaling
  3. emergent surgical intervention
  4. w/in 6 hours
  5. may be lost
49
Q

Dysmenorrhea
Def: -1- associated w/ -2-
> -3-:
» -4- of any pelvic -5-; most seen in adolescents

A
  1. pain and cramping
  2. menstruation
  3. Primary
  4. absence
  5. pathology
50
Q

Dysmenorrhea
> Primary
» The etiology of primary dysmenorrhea is believed to be -1-
» Most cases of primary dysmenorrhea -2- after -3-, with symptoms -4- until patients are in their -5-

A
  1. hormonal/endocrine-related
  2. begin 6-12 months
  3. menarche
  4. gradually increasing
  5. mid-20s
51
Q

Dysmenorrhea
> -1-
» results from a(n) -2- such as pregnancy, -3-, and -4-

A
  1. Secondary
  2. underlying cause
  3. pelvic inflammatory disease (PID)
  4. endometriosis
52
Q

Dysmenorrhea - S/S
> -1-
> Lower abdominal pain associated with menstruation, usually worse in the -2- of bleeding (-3-)
> Associated -4-
> May have -5-, fatigue, HA, and diarrhea

A
  1. Painful menses
  2. first few days
  3. (usually heavy bleeding at that)
  4. back pain (radiates to thighs)
  5. Nausea, vomiting
53
Q

Dysmenorrhea - Lab/Dx
> -1-: no testing is necessary; the -2-
> Testing for -3-: according to -4-

A
  1. Primary
  2. diagnosis is clincal
  3. Secondary dysmenorrhea
  4. suspected underlying cause
54
Q 
Dysmenorrhea - Mgmt
> -1-, proper -2-
> -3- measures
>> -4- application
>> -5-
A
  1. Education about menstruation
  2. diet
  3. supportive
  4. heat
  5. psychosocial support
55
Q

Dysmenorrhea - Support Measures

|&raquo_space; OTC analgesics, preferably -1-: 400 mg -2-, beginning -3- of -4- and continuing -5-

A
  1. ibuprofen
  2. Q4-6 hours,
  3. at the onset
  4. menstruation
  5. for 24-72 hours
56
Q

Dysmenorrhea - Mgmt
> -1- for -2- dysmenorrhea
> -3-
> -4-

A
  1. Stronger NSAIDs (naproxen)
  2. moderate to severe
  3. oral contraceptives
  4. referral as needed
57
Q

Bacterial Vaginosis
Def: a vaginal infection in which -1- of bacteria interact to -2-

Causes/Incidence
> -3- vaginal infection in women of -4-; may be seen in -5- as well

A
  1. several species
  2. alter the vaginal flora
  3. Most prevalent
  4. reproductive age
  5. prepubescent females
58
Q

Bacterial Vaginosis - Causes/Incidence

> -1- a(n) -2-; seen -3- in -4-

A
  1. Not considered
  2. STI
  3. more often
  4. sexually active women
59
Q

Bacterial Vaginosis - Causes/Incidence

> More common in females who use -1-, -2- soap products, or even -3-

A
  1. douches
  2. colored or scented
  3. bath bombs
60
Q

Bacterial Vaginosis - S/S
> May have -1-
> -2- (-3- in color); most prominent around -4- or -5-

A
  1. pruritis
  2. Malodorous “fishy” discharge
  3. thin, white to gray
  4. menstruation
  5. after sexual intercourse
61
Q

Bacterial Vaginosis - Labs/Dx
> -1-
» -2- covered with -3- (-4-) with -5-

A
  1. Wet mount
  2. Clue cells: epithelial cells
  3. bacteria appear stippled
  4. small dots or specks
  5. poorly defined borders
62
Q 
Bacterial Vaginosis - Labs/Dx
> Wet mount
>> -1-
>> -2-
> -3- test (-4- when -5- added to slide)
A
  1. Decreased/absent lactobacilli
  2. few or absent WBCs
  3. Postive amine “whiff” test
  4. fishy odor
  5. KOH
63
Q

Bacterial Vaginosis - Tx
> -1-
» -2- and -3-: 500 mg BID x 7 days OR
> -4-:
» -1- (0.75%), one applicator (5g)/day x 5 days OR
» -5- (2%), one applicator (5g) QHS x 7 days

A
  1. Metronidazole
  2. Children > 45 kg
  3. Adolescents
  4. Intravaginal
  5. clindamycin
64
Q

Hyperkalemia
The most common cause of hyperkalemia in infants and children is -1-, which refers to an elevated -2- on a laboratory test when the -3- -2- in the -4-. This phenomenon may arise from -5-.

A
  1. pseudo-hyperkalemia
  2. serum potassium concentration
  3. actual
  4. blood is normal
  5. tourniquet-related hemolysis (and other mechanical factors such as traumatic venipuncture/probing, small catheter diameters, excessive syringe force)
65
Q

Hyperkalemia
-1- may also occur secondary to -2- including -3-. Samples obtained via -4- in young infants are particularly susceptible to -5-.

A
  1. pseudo-hyperkalemia
  2. hematologic abnormalities
  3. leukocytosis or thrombocytosis
  4. heelstick
  5. hemolysis
66
Q

Hyperkalemia
When -1- is suspected, such as in the case of a child without -2- for hyperkalemia, a -3- should be obtained from a -4- before any -5-.

A
  1. pseudo-hyperkalemia
  2. symptoms or risk factors
  3. new specimen
  4. free-flowing venous sample
  5. treatment is administered
67
Q

Hyperkalemia
-1- hyperkalemia is typically associated with: -2- associated with -3-, extensive traumatic injuries, or in the presence of -4-; or with increased exogenous intake of potassium either through diet or supplementation, -5- or gastrointestinal bleeding.

A
  1. True
  2. inadequate excretion of potassium
  3. renal dysfunction
  4. significant acidosis
  5. blood transfusions, poisoning
68
Q

Hyperkalemia
A number of medications including -1-, and -2- can increase serum potassium levels. -3- is unlikely to cause significant increase in serum potassium levels.

A
  1. NSAIDs, potassium-sparing diuretics
  2. trimethoprim
  3. Dietary potassium
69
Q

Epididymitis, or inflammation of the epididymis, occurs most frequently in -1- and -2-, usually due to -3-.

A
  1. late adolescence
  2. early adulthood
  3. bacterial infection
70
Q

In -1-, the most common etiologies of epididymitis are -2-; in males who practice -3-, it may additionally be caused by -4- such as -5-.

A
  1. heterosexual men
  2. gonorrhea and chlamydia
  3. insertive anal sex
  4. enteric organisms
  5. E. coli
71
Q

Epididymitis presents typically with a gradual onset of -1-, -2-, and a -3-, indurated, and hard epididymis. -3-from epididymitis may be relieved with -4-, while in testicular torsion the symptoms present more acutely, and -4- makes -3- much -5-.

A
  1. redness
  2. scrotal swelling
  3. tender/pain
  4. scrotal elevation
  5. worse
72
Q

Varicoceles are -1- causing a painless mass in the -2-that often is described by the patient as feeling like “a -3-;” with prolonged standing activity, there can be increased -4- which is relieved when the individual -5-.

A
  1. enlarged vessels
  2. scrotum
  3. bag of worms
  4. dull aching pain
  5. reclines
73
Q

An inguinal hernia presents as a -1- in the inguinal area or scrotum -2- passing through a weakness in the -3-. A painful hernia is typically -4-, while a non–4- hernia can be -5-.

A
  1. swelling
  2. containing abdominal contents
  3. abdominal wall
  4. incarcerated
  5. reduced
74
Q

Primary nocturnal enuresis is a common problem in children between the ages of -1- years. In most cases, the symptoms will be -2-. Once any medical or physical problem is ruled out, -3- include limiting fluids after dinner, encouraging urination -4-, and holding the urine for -5- during the day.

A
  1. 5 and 8
  2. outgrown without treatment
  3. common sense approaches
  4. right before sleep
  5. longer periods
75
Q

Primary Nocturnal Enuresis
Common sense approaches do -1- in many cases and should be the -2- given to families.

Active treatment should not occur -3-, and punitive -4- to prevent harm to the child’s self-esteem. Alarm systems work well in waking the child when the first few drops of urine are sensed and are considered -5-.

A
  1. help
  2. first counseling information
  3. before age 6
  4. consequences are avoided
  5. first line treatment
76
Q

Primary Nocturnal Enuresis
Alarm systems have -1- than medications. Medications like -2- are also effective as long as they are used regularly, but -3- when they are stopped.

A
  1. lower relapse rates
  2. DDAVP and imipramine
  3. relapses can occur
77
Q

Male Genital Examination
The inability to retract the foreskin is normal until -1- of age. It is common for the -2- during an examination or to -3- in infancy and early childhood. In this age group placing a finger above the -4- and “milking down” the testis into the scrotum -5-.

A
  1. about 6 years
  2. testis to retract
  3. cold or touch
  4. inguinal canal
  5. prevents this retraction
78
Q

Male Genital Examination
Medical terminology for the whitish matter under the foreskin of the penis is -1-, and it is a -2-. A hydrocele is a -3- containing serous fluid. A hydrocele can further be classified as -4-.

A
  1. smegma
  2. normal body substance
  3. scrotal sac enlargement
  4. non-communicating or communicating
79
Q

Hydrocele
In a -1-, the scrotum is tense and non-reducible, the fluid does not fluctuate, and the hydrocele will -2-. A -3- is reducible, has a fluctuating fluid volume, and is more often associated with hernias. Therefore, if they persist -4-, -5- is warranted.

A
  1. non-communicating hydrocele
  2. resolve without intervention
  3. communicating hydrocele(s)
  4. at 1 year (12 months)
  5. referral for surgery
80
Q

A newborn with hypospadias must be referred to a -1- at -2-. One with an undescended testicle must be referred to a -1- in -3- to determine the course of treatment. Additionally, -4- abnormalities is indicated if the newborn has bilateral cryptochordism, and is -5- for a single undescended testicle.

A
  1. urologist
  2. birth
  3. a year
  4. karyotyping for chromosomal
  5. typically not necessary
81
Q

-1- such as -2- are highly unlikely to be responsible for a patient’s UTI. -1- cause UTIs but are not as common as -3- such as -4-, -5-, and -6- which are the most common bacterial agents responsible for UTIs.

A
  1. Gram-positive bacteria
  2. Enterococcus faecalis
  3. Gram-negative bacteria
  4. Escherichia coli
  5. Klebsiella
  6. Proteus

PNCB CPNP-PC (19 decks)

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