Genitourinary and Gynecological Issues and Disorders

Question 1

Enuresis defintion and types

Answer 1

involuntary urination occurs at any age when voluntary control should be present
Types:
primary: children who have never established control
secondary: dry for more than 6-12 months and begin wetting
nocturnal: incontinence during sleep
diurinal: occurs during waking hours

Question 2

Incidence of enuresis

Answer 2

40% in 3 yr olds
10% in 5 yr olds
3% in 10 yr olds
95% of all case are functional

Question 3

Management of enuresis

Answer 3

enuresis alarm, positive reinforcement chart
bladder control training–teach bladder to hold more
hypnosis/self hypnosis

medications:
imipramine–one hour before bedtime x1 week
DDAVP
oxubutynin–if less than 6 years old for detrusor muscle hyperactivity associated with neurological disorders

Question 4

UTI causative organisms

Answer 4

e coli 80-90%

staphylococcus aureus

Question 5

S/sx of UTI in infants

Answer 5

may be asymptomatic
weight loss, FTT
dehydration
irritability

Question 6

S/sx of UTI in children/adolescents

Answer 6

dysuria
frequency 
urgency 
nocturia
suprapubic, lower abdominal discomfort
hematuria 
fever

Question 7

Management of UTI

Answer 7

oral antibiotics for 10-14 days:
trimethoprim/sulfmethoxazole
cephalosporins
amoxicillin

• *follow up in 2 days and change antibiotic if not improvement
• *Follow up in 1-2 week, then every 1-3 months for a year for a UA

Children less than 2 months of age with a UTI should be hospitalized for IV antibiotics

Question 8

When to do a renal US and/or VCUG?

Answer 8

Renal US after first UTI in children 2-24 months and/or febrile infants
VCUG is indicated if US is abnormal

**antimicrobial prophylaxis is not indicated

Question 9

Hypospadias

Answer 9

common congenital abnormality in which urethral opening is on the ventral surface of the penis

**if baby has this, may have other GU abnormalities (undescended testes, inguinal hernia, hydrocele)

Question 10

S/sx of hypospadias

Answer 10

dorsally hooded foreskin **classic finding
urinary stream that aims downward
chordee (ventral bowing of the penis)

Question 11

Management of hypospadias

Answer 11

referrals to urologist at birth
circ must not be done bc foreskin is used in repair
surgery best around 6-12 months

Question 12

Cryptorchidism

Answer 12

undescended testes
very common in premature infants as descent typically happens in 3rd trimester

If doesn’t happen by 1 year–refer to urology
teach testicular self exam bc higher risk of testicular cancer

Question 13

Testicular torsion

Answer 13

twisting and strangulation of the spermatic cord characterized by acute pain; constitutes a surgical emergency to prevent necrotic testicle and infertility

• most often happens in the 10-20 age group

Question 14

Signs and symptoms of testicular torsion

Answer 14

acute onset of pain
affected testes may lie high
pain not relieved by elevating scrotum

Question 15

Phren’s sign

Answer 15

pain not relieved by elevating scrotum with testicular torsion

Phren–Penis

Question 16

Dysmenorrhea

Answer 16

pain and cramping with menstruation

Primary:absence of any pelvic abnormality, typically begin 6-12 months after menarche, with symptoms increasing until mid 20s

Secondary: underlying cause–pregnancy, PID, endometriosis

Question 17

Why does ibuprofen work for dysmenorrhea and how should you prescribe someone to take it?

Answer 17

400 mg every 4-6 hours beginning at the onset of the menstrual cycle and continuing for 24-72 hours

Take 2 days before and after

ibuprofen decreases prostaglandin release, which causes muscle cramps

Question 18

Chlamydia

Answer 18

parasitic STD
most common cause of cervicitis and urethritis in adolescents
most common in those 18-24 years old

Question 19

Female s/sx of chlamydia

Answer 19

often asymptomatic
dysuria
intermenstrual spotting
postcoital bleeding (after intercourse)
dyspareunia (painful intercourse)
vaginal discharge
lower abdominal/pelvic pain

Question 20

Males s/sx of chlamydia

Answer 20

often asymptomatic
dysuria
thick, cloudy penile discharge
testicular pain

Question 21

What test is used to check for chlamydia?

Answer 21

enzyme immunoassay for screening–results in 30-120 min, cheap

culture is most definitive but takes 3-9 days

Question 22

Management of chlamydia

Answer 22

azithromycin– 1 gram in single oral dose
doxycycline 100 mg orally twice a day x 7 days
report to health department

Question 23

Gonorrhea

Answer 23

bacterial STD–can be cultured from GU tract, oropharynx, conjunctiva, and anorectum

leading cause of infertility in females

Question 24

S/sx of gonorrhea in females

Answer 24

80% asymptomatic
dysuria
urinary frequency
mucopurulent discharge 
labial pain/swelling
lower abdominal pain
fever
dysmenorrhea
nasuea and vomiting

Question 25

S/sx of gonorrhea in males

Answer 25

dysuria frequency white/yellow, green penile discharge testicular pain

Question 26

Lab tests for gonorrhea

Answer 26

gram stain of discharge shows gram-negative diplococci and WBCs cervical culture using thayer-martin or transgrow media

Question 27

Management of gonorrhea

Answer 27

ceftriaxone IM one dose azithromycin 1 gram orally x 1 dose (covers chlamydia) doxycycline 100 mg orally x 2 daily x 7 days co-treat for chlamydia report to health dept

Question 28

Syphilis

Answer 28

STD caused by treponema palladium, a spirochete--which can be transmitted across the placenta

Question 29

What is the primary diagnosis of syphilis, secondary and latent diagnosis of syphilis?

Answer 29

primary: typical lesion or newly positive syphilis screen--dark filed microscopy shows treponemes in 95% of chancres secondary: clinical presentation with strongly reactive syphilis screen latent/tertiary: serologic evidence of untreated syphilis

Question 30

Primary stages of syphilis

Answer 30

chancre present at site of inoculation 2-6 weeks after exposure chancre indurated and painless regional lymphadenopathy

Question 31

Secondary stages of syphilis

Answer 31

occurs 6-8 weeks later flu-like symptoms generalized lymphadenopathy generalized maculopapular rash, especially on palms/soles

Question 32

Latent and tertiary stages of syphilis

Answer 32

latent: seropositive, but asymptomatic , about 1/3 untreated cases develop tertiary tertiary: leukoplakia, cardiac insufficiency, infiltrative tumors of skin, bones, liver, and CNS involvement

Question 33

Serologic tests of syphilis

Answer 33

general disease research lab (VDRL) and/or rapid plasma reagin Confirmed with treponema tests

Question 34

Management of syphilis

Answer 34

penicillin G or doxycycline or erythromycin in those allergic to penicillin report all cases to health department

Question 35

Bacterial Vaginosis

Answer 35

a vaginal infection to which several species of bacteria interact to alter the vaginal flora most prevalent vaginal infection in women of reproductive age not considered an STD/STI, but seen more often in sexually active women

Question 36

Symptoms of bacterial vaginosis

Answer 36

increased milky discharge may have pruritus malodorous "fishy" discharge most evident after sexual intercourse

Question 37

Wet mouth of bacterial vaginosis

Answer 37

clue cells--epithelial cells covered with bacteria decreased/absent lactobacilli few or absent WBC post amine whiff test--fishy odor with KOH added to slide

Question 38

Treatment of bacterial vaginosis

Answer 38

metronidazole PO clindamycin PO **or intravaginal of either

Question 39

Herpes

Answer 39

recurrent, viral STD associated with painful lesions that you have for rest of life caused by HSV type 1: lips, face, mucosa type 2: genitalia Transmission by direct contact with active lesion or by virus containing fluid

Question 40

Signs and symptoms of herpes

Answer 40

initial: fever, malaise, dysuria, painful/pruritic ulcers for 12 days recurrent: less painful/pruritic ulcers for 5 days

Question 41

lab diagnosis of herpes

Answer 41

papanicolaou or tzanck stain | viral culture is most definitive

Question 42

Management of herpes

Answer 42

no curative treatment symptomatic treatment with drying and antipruritic agents treatment options: acyclovir: topical, oral, IV valacyclovir: especially useful for asymptotic viral shredding of HSV-2

Question 43

AIDS epidemiology

Answer 43

characterized as the result of infections by HIV modes of transmission typically maternal infant perinatal transmission breastfeeding is primary positional vertical route (contraindicated)

Question 44

Signs and symptoms of AIDS

Answer 44

low birth weight and falling ratio of head circumference to height/weight recurrent infections diminishing activity developmental delay hepatosplenomegaly, generalized lympahdenopathy

Question 45

Screening and confirmatory testing for AIDS

Answer 45

in infants: HIV PCR testing in older children: ELISA screening is used western blot test is confirmatory

Question 46

Progress towards AIDS

Answer 46

absolute CD4 lymphocyte count: normal >800 | CD4 lymphocyte percentage of WBC--risk for progression of AIDS is high when

Question 47

Prevention of opportunistic infections in those with HIV

Answer 47

trying to prevent from HIV turning into AIDS bactrim for pneumocystitis pneumonia prevention monitor for CMV

Question 48

Antiretroviral treatment in those with HIV

Answer 48

combination treatment--with antiretroviral therapy start no later than when the patient has a CD4 of 350 drug resistance develops readily--take meds exactly as prescribed at same time each day