Genitourinary and Gynecological issues and disorders Flashcards by W W

Involuntary urination occurs at an age when voluntary control should be present

Enuresis

How well did you know this?

Not at all

Perfectly

Involuntary urination: Children who have never established control

Primary Enuresis

How well did you know this?

Not at all

Perfectly

Involuntary urination: Dry for more than six to 12 months and begin wetting

Secondary

How well did you know this?

Not at all

Perfectly

Involuntary urination: Incontinence during sleep

Nocturnal enuresis

How well did you know this?

Not at all

Perfectly

Involuntary urination: Occurs during waking hours

Diurnal enuresis

How well did you know this?

Not at all

Perfectly

Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 3-year-olds

40%

How well did you know this?

Not at all

Perfectly

Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 5-year-olds

10%

How well did you know this?

Not at all

Perfectly

Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Up to ___% in 10-year-olds

How well did you know this?

Not at all

Perfectly

Incidence:
The incidence of enuresis is difficult to assess; however, the estimated rat are:
Approximately ____% of cases are functional

95%

How well did you know this?

Not at all

Perfectly

Signs and symptoms of enuresis:

HIstory of _____ wetting

bed

How well did you know this?

Not at all

Perfectly

Laboratory/ diagnostics:

______
Urine culture

Urinalysis

How well did you know this?

Not at all

Perfectly

Management:
_______ enuresis
a. Enuresis alarm, positive reinforcement such as
utilizing a star chart
b. Bladder control training (geared toward training the
bladder to hold more urine)

Functional enuresis

How well did you know this?

Not at all

Perfectly

Managment:
Functional enuresis
c. Medications:
i. _______ 25 mg daily one hour before bedtime
time one week
ii. Desmopressin (DDAVP): available orally
iii. Oxybutynin (Ditropan): if less than six years for
detrusor muscle hyperactivity associated with
neurological disorders (spina bifida); 5 mg may be
given twice a day to a maximum of 5 mg three
times daily

c. i. Imipramine

How well did you know this?

Not at all

Perfectly

Management for enuresis: Treat urinary tract _____ (__) if indicated

Urinary tract infection (UTI)

How well did you know this?

Not at all

Perfectly

Bacterial infection and inflammation of the urinary tract are more common in males (uncircumcised) in the first year of life. Increases are seen in females at a 10: 1 ratio throughout the lifespan.

Urinary tract infection

How well did you know this?

Not at all

Perfectly

Both the male and female UTI in childhood are typically caused by the following organism

a. ___ ___ 80 to 90%
b. _____ _____

a. E. Coli

b. Staphylococcus aureus

How well did you know this?

Not at all

Perfectly

Predisposing factors include urinary _____, congenital or acquired obstructive lesions, non-obstructive causes ( e.g. neurologic bladder, poor hygiene, constipation, and sexual intercourse)

stasis

How well did you know this?

Not at all

Perfectly

High-grade ______ reflux (VUR) may result in renal scarring, eventual hypertension, and renal failure related to urinary tract infection

vesicoureteral

How well did you know this?

Not at all

Perfectly

Signs and symptoms of UTI in Infant include:

a. May have ____ signs or symptoms
b. Weight loss, FTT
c. dehydration
d. irritability

How well did you know this?

Not at all

Perfectly

Signs and symptoms of UTI in children and adolescents include:

a. dysuria
b. _______
c. urgency
d. nocturia
e. suprapubic/ lower abdominal discomfort
f. hematuria
g. fever

b. frequency

How well did you know this?

Not at all

Perfectly

Laboratory/ diagnostics for UTI:
a. A straight catheter (cath) or bladder tap for
culture/sensitivity is indicated in those who cannot void
voluntarily [ clean catch may be used for mild symptoms
or follow up]
b. UA: Leukocytse, ______, nitrites
c. ______ in the complete blood count (CBC)

b. erythrocytes

c. Leukocytosis

How well did you know this?

Not at all

Perfectly

Management of UTI:

Oral antibiotics for 10 to 14 days
a. [trimethoprim/sulfamethoxazole
b. Cephalosporins
c. Amoxicillin
d. Sulfisoxazole
e. ___________

e. Nitrofurantoin

How well did you know this?

Not at all

Perfectly

UTI:
Follow up in ___ days; change antibiotics if no improvement is seen.
Follow up in one to two weeks, then every one to three months for one year

two

How well did you know this?

Not at all

Perfectly

Note: Children < ____ months of age with UTI should be hospitalized for parental antibiotics

2 months

How well did you know this?

Not at all

Perfectly

Management for UTI: a. Febrile infants b. children 2 to 24 months ______ is indicated if ultrasound abnormal Antimicrobial prophylaxis is not indicated

VCUG

A relatively common congenital abnormality in which the urethral opening is on the ventral surface (underside) of the penis

Hypospadias

a. The etiology is unclear; currently hypothesized to be a deformity rather than a malformation b. Occurs in 8.2: 1,000 live births or 1: 300 male infants; often familial c. Likelihood of other genitourinary (GU) anomalies such as undescended testicles, inguinal hernia. or hydrocele is noted

Hypospadias

Signs and symptoms of hypospadias 1. Dorsally hooded foreskin (classic finding) 2. urinary stream that aims downward 3. _______ (ventral bowing of the penis)

3. Chordee

Laboratory/ Diagnostics: hypospadias 1. ___ lab test 2. Diagnosis is made by clinical findings

Management: hypospadias 1. Referral to a urologist at birth 2. circumcision must ____ ___done (Foreskin is used in repair) 3. Surgery is best done around 6 to 12 months of age

2. not be

Absence of one or both of the testes from the scrotal sac due to failure to decent from the abdomen in utero 1. Occurs in 3% of newborn males and 20 to 30% of the premature male newborn (descent normally occurs during the last trimester)

Cryptorchidism (Undescended Testes)

Signs and symptoms of cryptorchidism 1. Inability to palate ______ 2. Often no symptoms

1. testicle

Laboratory/ diagnostics: cryptorchidism 1. None typically 2. If bilateral, karyotyping for _______ abnormalities may be ordered

2. chromosomal

Management: cryptorchidism 1. If undescended at ___ years refer to urology 2. Testicular self- examination (TSE) for increased testicular cancer probability

1. 1 year

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

Testicular torsion

Cause/Incidence of Testicular Torsion: 1) Occurs most often in ____ to __ age group 2) Does not represent an infectious process 3) Interruption of the vascular flow produces acute pain

10 to 20 age group

Signs and symptoms of Testicular torsion: 1) Acute onset creates profound pin 2) Lack of irritative voiding symptoms 3) No systems symptoms and no fever 4) The affected testis may have a " high lie" 5) Pain is not relieved by elevating scrotum 6) Absent __________ reflex

6) cremasteric

Stroking inner thigh results in retraction of the testicle on the same side

Creamateric reflex

Laboratory/ diagnostics: Testicular torsion | 1) ______ in primary care

1) None

Management of Testicular torsion: | 1) Refer for emency _______ intervention

surgical

Pain and cramping associated with menstruation?

Dysmenorrhea

________ dysmenorrhea a) Absence of any pelvic pathology; is most commonly seen in adolescents b) The etiology of _______ dysmenorrhea is believed to be hormonal and endocrine-related c) Most causes of _____ dysmenorrhea begin 6 to 12 months after menarche, who symptoms gradually increasing until patients are in their mid-20s.

Primary

________ dysmenorrhea results from an underlying cause wich as pregnancy, pelvic inflammatory disease (PID), and endometriosis

Secondary

Signs and symptoms of dysmenorrhea include: 1) Painful menses 2) Lower abdominal pain associated with menstruation, usually worse in the first few days of bleeding 3) Associated pain 4) May be nausea, vomiting, fatigue, headache, and diarrhea

3) back

Laboratory/ diagnostics for dysmenorrhea include: a) ______ dysmenorrhea: No testing necessary; diagnosis is made clinically b) Testing for ____ dysmenorrhea: according to the suspected underlying cause

a) Primary | b) Secondary

Management of dysmenorrhea include: 1) Education about menstruation proper diet 2) Support measure: a) Heat application b) Psychological support c) Over the counter (OTC) analgesics, preferably ________: 400 mg every four to six hours, beginning at the onset of the menstrual cycle and continuing for 2 to 72 hours 3) Stronger non-steroidal anti-inflammatory drugs (NSAIDs) for moderate to severe dysmenorrhea 4) Oral contraceptives 5) Referral as needed

2) c) ibuprofen

A parasitic sexually transmitted disease, intracellular obligate which closely resembles a gram-negative bacteria; produces serious reproductive tract complications in with sex

Chlamydia

Causes/ Inceidnece of this STD. It occurs from Chlamydia trachomatous

Chlamydia

Most common bacterial STD in the United States.

Chlamydia

Over four million infections annually from this STD?

Chlamydia

Remains the most common cause of cervicitis and urethritis in adolescents

Chlamydia

Signs and symptoms of Chlamydia include: 1) Female often _______ a) Dysuria b) intermenstrual spotting c) postcoital bleeding d) dyspareunia e) vaginal discharge f) lower abdominal and pelvic pain g) rectal tenesmus

1) asymptomatic

Signs and symptoms of Chlamydia include: 2) Male often asymptomatic a) Dysuria b) thick, cloudy, penile discharge c) testicular pain d) rectal __________

2) d) tenesmus

Laboratory/ diagnostics of Chlamydia include: a) Culture is most definitive but takes three to nine days b) ______ _____ (__) for screening: Results in 30 to 120 minutes; low cost

b) Enzyme immunoassay (EIA)

Management of Chlamydia include: 1) _______ (_____) one gram orally in single dose or: 2) _______ (______) 100 mg orally twice a day for seven days 3) _____, ______, or _______ if pregnant

1) Azithromycin (Zithromax) 2) Doxycycline (Vibramycin) 3) Azithromycin, erythromycin, or amoxicillin

A bacterial STD caused by Neisseria gonorrhoeae (gram-negative diplococci); the organism may be cultured from the genitourinary tract, oropharynx, conjunctiva and or anorectal

Gonorrhea

Cause/ Incidence of Gonorrhea include: 1) Causes urethritis in men and cervicitis in women 2) Leading cause of ______ among females

2) infertility

Signs and symptoms of Gonorrhea include: 1) Females are often asymptomatic (____%) a) Dysuria b) Urinary frequency c) Mucopurulent vaginal discharge d) Labial pain/ swelling e) Lower abdominal pain f) fever g) ____________ h) nausea/ vomiting

1) 80% | g) dysmenorrhea

Signs and symptoms of Gonorrhea include: 2) Male is often asymptomatic a) Dysuria b) Frequency c) _____/__________ penile discharege d) Testicular pain

c) White/ yellow-green

Laboratory/ diagnostics for Gonorrhea: 1) Gram stain of discharge shows gram-_____ ______ and white blood cells (WBCs) 2) Clerical culture for N.gonorrhoeae using Thayer-Marting or Transgrow media

1) negative diplococci

Management of Gonorrhea infection include: 1) _____________ intramuscular single dose 2) _______ ( ___) 1 gram orally x 1 dose to cover for chlamydia 3) ________ 100 mg orally x2 daily for seven days 4) Co- treat for chlamydia 5) All contact should be treated 6) Report to the health department

1) Ceftriaxone (Rocephin) 2) Azithromycin ( Zithromax) 3) Doxycycline

A sexually transmitted disease involving multiple organ systems and caused by Treponema pallidum a spirochete; the causative organism may be transmitted across the placenta

Syphilis

_______: Typical lesion or nearly positive syphilis screen | a) dark-field micsopy show treponemes in 95% of chances

Primary

________: clinical presentaiton with strongly reactive syphilis screen

Secondary

Latent _______: serologic evidence of untreated syphilis

Tertiary

_________ a. Chancre presents at the site of inoculation two-six weeks after exposure b. Chancre indurated and painless c. Regional lymphadenopathy

Primary

_______ syphilis a) Seropositive, but asymptomatic b) About 1/3 of untreated cases develop ____syphilis

Latent | b) tertiary

_________ a) Occurs six to eight weeks later b) Flu-like symptoms c) Generalized lymphadenopathy d) Generalized maculopapular rash, especially on the palms and soles

Secondary

_________ a) Leukoplakia b) Cardiac insufficiency: aortic, aneurysms, aortic regurgitation c) Infiltrative tumors of skin, bones, liver d) Central nervous system (CNS) involvement: meningitis, hemiparesis, hemiplegia, others

Tertiary

Serologic test: syphilis 1) Screening with non-________ antibody test: Veneral disease research laboratory (VDRL) and/ or rapid plasma reagin (RPR) 2) Confirmed with treponemal tests a) Fluorescent treponemal Antibody Absorption (FTA- ABS): Following the non- treponemal screen. b) Microhemagglutination Assay for Antibody to Reeponema Pallidim (MHA-TP)

1) treponemal

Management of Syphilis is: | a) ____________________

a) Benzathine Penicillin G

Management of Syphilis with PCN allergy is? a) ___________ b) ___________

a) Doxycycline | b) Erythromycin

Syphilis _______ all cases to the health department

report

A vaginal infection in which several species of bacteria interact to alter the vaginal flora

Bacterial Vaginosis

Cause/ Incidence: bacterial Vaginosis 1) Increased pH and decreased __________ 2) Most prevalent vaginal infection in women of reproductive age 3) ______ considered an STD/STI; seen more often in sexually active women

1) lactobacilli | 3) Not

Signs and symptoms of bacterial vaginosis a) increased ____ discharge b) may have pruritus c) Malodours "_____" discharge most evident after sexual intercourse d) Cervicx/uterus/ adnexa within normal limits

a) milky | c) fishy

Laboratory/ Diagnostics for bacterial vaginosis 1) Wet mount a) ____ cells: Epithelial cells covered with bacteria appear stippled (small dots or specks) with poorly defined borders b) decreased/ absent lactobacilli c) Few or absent WBC 2) Positive amine "whiff" test (fishy odor when potassium hydroxide (KOH) added to slide)

1) a) Clue cells

Laboratory/ Diagnostics for bacterial vaginosis | 2) Positive amine "____" test (fishy odor when potassium hydroxide (KOH) added to slide)

2) "whiff"

Treatment for bacterial vaginosis: 1) ________ PO 2) ________ PO 3) Intravaginal ______ or _______

1) Metronidazole 2) Clindamycin 3) metronidazole or clindamycin

A recurrent, viral sexually transmitted disease that is associated with painful lesions

Herpes

Herpes-type ____: Found on the lips, face, and mucosa

Type 1

Herpes-type ____: Found on the genitalia

Type 2

Transmission by _____ contact with active lesions or by circus containing fluid (e.g. saliva or cervical secretions)

direct

Signs or symptoms for ______ 1) Initial Fever, malaise, dysuria, painful/ pruritic ulcer for 12 days 2) Recurrent: Less painful/ pruritic ulcers for 5 days

Herpes

Laboratory/ diagnostics for herpes include? 1. _____ or Tzanck stain 2. ____ _____ is most diefinitivae

1. Papanicolaou | 2. Viral culture

Managment of herpes include? 1. _____ _____ treatment 2. Symtomatic treatment with drying and antipruiritic agents 3. Treatment options a. ______ topical, oral, IV b. ________ especially useful for asymptomatic viral shedding of HSV-2

1. No curative treatement 3. a. Acyclovir ( Zovirax) b. Valacyclovir

A disorder characterized by immunodeficiency as the result of infections by the human immune deficiency virus

Acquired Immune deficiency syndrome (AIDS)

Mode of transmission typically with AIDS is how?

Maternal infant perinatal transmission

______ is primary postanatl vertical route

Breastfeeding

Signs and symptoms of ______ include a) Low birth weight and the falling ratio of head circumference to height/weight b) Recurrent infections c) diminished activity d) developmental delay e) hepatosplenomegaly, generalized lymphadenopathy

Acquired Immune deficiency syndrome (AIDS)

Screening in infants 1) ____ birth weight and a falling ration of head circumference to height /weight 2) recurrent infections 3) diminished activity 4) developmental delay 5) hepatosplenomegaly, generalized lymphadenopathy

1) Low

Laboratory/ diagnostics Screening in infants for HIV includes?

HIV polymerase chain reaction (PCR)

In older children, the ____-____ _____ ____ (___) screening is used (sensitivity >99.9%)

enzyme-linked immunosorbent assay (ELISA)

Confirmatory test for laboratory AIDS?

The western blot test is confirmatory

Progress towards AIDS a) absolute CD4 lymphocyte count: Normal > ____ cells/uL b) CD4 lymphocyte percentage of WBC 1) Risk of progression to AIDs high when < ___% c) Viral load ideally, should be < 5000 copies, or " zero" or "undetectable"

a) >800 cells/uL | b) 1) < 20%

Management of opportunistic infections with AIDS a) ____ for pneumocystis pneumonia (Pneumocystis jiroveci) preventions b) Monitor for ____

a) Bactrim | b) CMV

Management of AIDS with antiretroviral treatment a) combination treatment : With ______ _____ (___) b) Start no later than when the patient has a CD4 of 350uL c) Drug resistance may develop readily; teach to take the medication exactly as prescribed: at the same time every day d) Referral to an HIV infectious disease specialist

a) antiretroviral therapy (ART)

Management of Menopause? a) Hormonal therapy ii) Estrogen: Conjugated estrogen (_____), estradiol (Estrace, Estraderm, Climara), Estrone sulfate

Premarin

Management of Menopause: | b) ______: cyclic or continuous (not necessary if hysterectomy)

Progestin

Management of Menopause: c) ______, calcium supplementation (recommended in the present and absence of estrogen), and diet if HT is contraindicated or refused

c) Exercise

Management of Menopause: d) Benefits/ risk must be made based on the three major possible concerns in family history: i) _____ cancer ii) Myocardial infarction/ CAD iii) Uterine cancer

i) Breast cancer

Change of bone structure due to graduation in quantity, rather than composition, resulting in an abnormally low bone mass leading to increased risk of fractures

Osteoporosis

____ sexes experience a bone loss with again (type 2 osteoporosis)

Both

Osteoporosis in menopause results from the loss of stronger (type ___ osteoporosis)

___ of bone loss is due to hypoestrogenic states rather than to the aging process itself

3/4

In younger women, screen for the female athlete triad: a) Eating disorders and/ or excessive exercise lead to: b) ________ which least to : c) Decreased amounts of estrogen, resulting in bone loss

b) Amenorrhea

Risk factors of Osteoporosis: a) Female, white, or ______ b) Elderly c) Early menopause d) Estrogen deficiency e) The small frame or underweight f) Family history g) High consumption of caffeine, phosphate, protein, sodium h) smoking i) Low intake of dietary calcium j) Sedentary lifestyle k) Alcoholism

a) Asian

Medication like _____ _____, corticosteroids, anticonvulsants are risk factors that lead to osteoporosis

thyroid hormone

Certain disease (e.g. thyroid and parathyroid conditions, ____ _____, liver dysfunction, intestinal malabsorption, COPD) lead to osteoporosis

kidney disease

Testing for osteoporosis: a) __________________________ i) Measures amount of bone tissue in the hip, spine, wrist, and ankle ii) results are reported as T and Z scores a) T score is the number of standard deviations (SD) around the mean bone density for race and enter b) The Z score compares the patient with population adjusted for gender, age, and race

Dual-energy x-ray absorptiometry (DEXA)

Testing for osteoporosis: a) Dual-energy x-ray absorptiometry (DEXA) i) Measures amount of bone tissue in the hip, spine, wrist, and ankle ii) results are reported as _____ scores a) ___score is the number of standard deviations (SD) around the mean bone density for race and enter b) The Z score compares the patient with population adjusted for gender, age, and race

ii) T and Z | a) T

Testing for osteoporosis: a) Dual-energy x-ray absorptiometry (DEXA) i) Measures amount of bone tissue in the hip, spine, wrist, and ankle ii) results are reported as ____ scores a) T score is the number of standard deviations (SD) around the mean bone density for race and enter b) The ___ score compares the patient with population adjusted for gender, age, and race

ii) T and Z | b) Z

Testing for Osteoporosis with T score : | a) T score: _____ SD normal

> -1.0

Testing for Osteoporosis with T score : | b) Between _________ is osteopenia (now called "low bone mass")

-1.0 to -2.5

Testing for Osteoporosis with T score : | c) below _____is osteoporosis

-2.5

Bone density testing recommendations a) All women ___ years of age b) all postmenopausal women < 65 years of age with one or more additional risk factors: i) Family history ii) Smoking iii) Excessive exercise iv) excessive alcohol use v) Corticosteroid use vi) Hyperthyroidism vii) slender body size c) Postmenopausal women with fractures d) Patients considering treatment for osteoporosis for decision making e) Women on hormone therapy for extended periods of time

> 65

Prevention: 1) Estrogen replacement therapy (as above) 2) Avoiding known risk factors 3) Weight exercise to strengthen bone a. ______ ___ of moderate exercise 3 to 5 times a week b) Walking, jogging, dancing, climbing stairs, aerobics, strength training 4. Increase calcium intake or supplementation (see chart below; exact numbers may slightly vary)

30 minutes

Calcium Recommendation/ Day: | Male 14 to 18 years is ______ mg

1300 mg

Calcium Recommendation/ Day: | Female 14 to 18 years is ____ mg

1300 mg

Calcium Recommendation/ day: | Male 19 to 50 years is ____ mg

1000 mg

Calcium Recommendation/ day: | Female 19 to 50 years is ____ mg

1000 mg

Calcium Recommendation/ day: | Male 51 to 70 years is ____ mg

1000 mg

Calcium Recommendation/ day: | Female 51 to 70 years is ____ mg

1200 mg

Calcium Recommendation/ day: | Male 71+ years is ____ mg

1200 mg

Calcium Recommendation/ day: | Female 71+ years is ____ mg

1200 mg

Dietary source of calcium: a. Dairy products, sardines, salmon with bones b. Green leafy vegetables, tofu, calcium-fortified foods c. Take Vitamin D (______ IU/day)

c. 800 to 1000 IU/day

Supplements a. Most common: Calcium carbonate = greatest amount of elemental calcium (40%) b. Should not be taken with ____ ___ foods c. Avoid aluminum-containing antacids (Ca++ binds with aluminum)

b. high fiber

Drug Therapies Osteoporosis: a. Estrogens b. ___________: Potential but rare reports of bisphosphonate-associated osteonecrosis of the jaw (BON) associated with this class of medication, especially in women with an underlying diagnosis of cancer. The FDA has not seen a clear connection between bisphosphonates use and the risk of atypical subtrochanteric femur fractures.

Bisphosphonates

Oral _________ are: a) Risedronate (Actonel) b) Alendronate (Fosamax) c) Ibandronate (Boniva)

bisphosphonates

Elevated calcium levels often due to ______________

hyperparathyroidism

IV bisphosphonates: a) b)

a) Ibandronate (Boniva) | b) Zoledronic acid (Reclast)

Multisystem, an inflammatory autoimmune disorder that affects primarily women of childbearing age

Systemic Lupus Erythematosus (SLE)

Signs and Symptoms: Systemic Lupus Erythematosus (SLE): 1. Fever 2. Anorexia 3. Malaise 4. Weight loss 5. ____ ____ (affects < 50% patients) 6. Fingertip lesions 7. Periungual erythema 8. Splinter hemorrhages 9. Alopecia 10. Raynaud's phenomenon in 20% of patients 11. Joint symptoms often an early manifestation 12. Photosensitivity 13. Vasculitis 14. _____ 15. Ocular manifestations 16. Pericardial manifestations 17. Pulmonary manifestations 18. Abdominal pains, ileus, peritonitis

5. Butterfly rash | 14. Nephritis

Laboratory/Diagnostics: Systemic Lupus Erythematosus (SLE): 1. ANA + in equal to ____% patients 2. Antiphospholipid antibodies 3. Anemia, leukopenia, and thrombocytopenia are often present

95%

Management: Systemic Lupus Erythematosus (SLE): 1. For mild symptoms: bed rest, midafternoon naps, avoidance of fatigue 2. ____ ______ 3. Topical glucocorticoid for isolated skin lesions 4. NSAIDs, hydroxychloroquine, glucocorticoids, and other therapies

2. Sun protection

Drugs implicated in Lupus Like Syndrome: 1. _______ 2. Atenolol (Tenormin) 3. Bupropion (Wellbutrin) 4. Captopril (Capoten) 5. Carbamazepine (Tegretol) 6. Chlorpromazine (Thorazine) 7. Diltiazem (Cardizem) 8. Gemfibrozil (Lopid) 9. Glyburide (Diabeta) 10. ________ 11. Griseofulvin 12. Hydralazine (Apresoline) 13. Hydroxychloroquine (Plaquenil) 14. Isoniazid (tNn) 15. Interferons 16. _______ 17. Lovastatin (Mevacor) 18. Methyldopa (Aldomet) 19. Minocycline (Dynacin) 20. Nitrofurantoin (Macrobid) 21. Oral contraceptives 22. Phenytoin (Dilantin) 23. Procainamide (Pronestyl) 24. Propylthiouracil (PTU) 25. Quinidine 26. _______ 27. Simvastatin (Zocor) 28. Tetracycline 29. Ticlopidine (Ticlid) 30. Valproate

1. Amiodarone (Cordarone) 10. Gold salt 16. Lithium 26. Rifampin

Inflammation and infection involving the kidneys, ureters, bladder, and/or urethra Causes

Urinary Tract Infections (UTIs)

______ UTIs: Pyelonephfitis, Renal Abscess, etc.

Upper

_______ is the most common causative organism in women.

E. coli

_____ UTIs: Cystitis, Urethritis/Dysuria Frequency Syndrome

Lower

Signs/Symptoms of Lower UTIs: 1. Dysuria is the key symptom Frequency 2. Nocturia 3. Urgency 4. Hematuria - occurs in _____% of patients

40 to 60

Organisms of the ____ species are most common in men.

Proteus

Laboratory/Diagnostics 1. Urinalysis - usually shows pyuria (> ____ white blood cells/ml) 2. The presence of _____ by dipstick is very specific but not a sensitive test for bacteriuria. 3. Esterase detection by dipstick is very sensitive but not specific.

1. 10 | 2. nitrate

Management of Lower UTIs: 2. Commonly used agents: [_____-______] (Bactrim), ciprofloxacin (Cipro) and amoxicillin/clavulanate (Augmentin) 3. Other considerations: Amoxicillin (Amoxil), levofloxacin (Levaquin), nitrofurantoin (Macrobid; Macrodantin), trimethoprim (Primsol), fosfomycin (Monurol)

Trimethoprim-sulfamethoxazole

Management of Lower UTIs: 1. ___-day therapy maximizes benefits and minimizes drawbacks of treatment (i.e., fewer side effects, more effective than single-dose, and less costly than a 7-day course)

Management of Lower UTIs: | 4. During pregnancy: ______ (__), nitrofurantoin (Macrobid), cephalexin (Keflex) for 7 to 10 days of therapy

Amoxicillin (Amoxil)

Acute Pyelonephritis: Laboratory/Diagnostics 1. ___ ____ cell casts seen on urinalysis 2. ESR elevated with pyelonephritis

1. White blood

Symptoms/Physical Findings of Upper UTIs 1. Flank, low back, or abdominal pain may be present 2. Fever and chills often present and usually indicate upper UTI** 3. Nausea/Vomiting 4. Mental status changes in the elderly

Acute Pyelonephritis

Management of Upper UTls 1. ___-day course vs. 6-week course 2. Commonly used agents: [Trimethoprim-sulfamethoxazole] (Bactrim), ciprofloxacin (Cipro), other Quinolone, amoxicillin/clavulanate (Augmentin), Aminoglycosides (Gentamicin, Tobramycin, etc.) 3. Patients with suspected pyelonephritis who have nausea and vomiting and those with more severe illness should be hospitalized.

1. 14- day

Urinary Incontinence 1. Urinary incontinence is common b. Affects ___% of postmenopausal women 2. Associated with chronic risks such as falls and fractures 3. Costly diagnosis: roughly $26 billion/annually (more than all cancer care for women)

40%

Urinary Incontinence 1. Urinary incontinence is common a. Affects ___% of reproductive-age women 2. Associated with chronic risks such as falls and fractures

25%

Urinary Incontinence 3. Costly diagnosis: roughly $___ billion/annually (more than all cancer care for women)

______ (urethral incompetence) a. Causes 1) Muscles impairing urethral support (most common) 2) Intrinsic sphincter deficiencies due to pelvic surgery

Stress

``` ____ (detrusor overactivity) a. Causes 1) Detrusor hyperactivity by CNS abnormalities such as strokes 2) Infections of the GU tract 3) Urinary stones 4) Neoplasms 5) Fecal impaction ```

Urge

Symptom: Stress Incontinence a) Precipitant b) Timing c) Amount d) Frequency e) Nocturia

a) activity b) Immediate c) Small/ moderate d) rare e) rare

b. Findings 1) Urine leakage from activities with increased pressure on the bladder (lifting, coughing, exercise, sneezing, laughing, climbing stairs, etc.)

Stress (urethral incompetence)

Management incontinence: | 1. _____ of recent urinary activities (e.g., fluids, voids, and incontinence events)

Diary

b. Findings Urgency, involuntary urinary loss, nocturia, frequency Often referred to as an "overactive bladder"

Urge (detrusor overactivity)

Symptom: Urge Incontinence a) Precipitant b) Timing c) Amount d) Frequency e) Nocturia

a) Urge b) Delayed c) Large d) Common e) Common

2. ______ incontinence a. Timed voids to prevent full bladder b. Pessary c. Surgery

Stress

4. Patient teaching a. Weight loss: Improved urge incontinence (great motivator for weight loss) b. Fluid management: Drink for ____ only; lozenges for dry mouth c. Avoid caffeine d. Pelvic floor exercises: Squeeze, hold for 2 seconds, relax for 2 seconds (increase each by one second every week until 10 seconds is achieved)

b. thirst

3. ______ incontinence a. Urge suppression/distraction b. Quick pelvic contractions c. Medication

Urge

e. Bladder control strategies 1) ____ control: Freeze and squeeze

1) Urge

e. Bladder control strategies | 2) ____ control: Squeeze before you sneeze (lift)

2) Stress

``` Pharmacotherapy: Muscarinic receptor antagonists Immediate release 1) _______ (Ditropan) 2) Tolterodine (Detrol) 3) Trospium (Sanctura) ```

1) Oxybutynin

``` Pharmacotherapy: Muscarinic receptor antagonists Extended-Release 1) Darifenacin (Enablex) 2) __________ (Toviaz) 3) Ditropan XL 4) Solifenacin (Vesicare) 5) Detrol LA 6) Oxybutynin transdermal (Oxytrol) 7) Oxybutynin gel (Gelnique) ```

Fesoterodine

``` Tanner Staging in boys 1) 2) Enlargement of scrotum and testes; scrotum roughens and reddens 3) Penis elongates 4) Penis enlarges in breadth and development of glans; rugae appear 5) Adult shape and appearance ```

1) Preadolescent testes, scrotum, penis

``` Tanner Staging in boys 1) Preadolescent testes, scrotum, penis 2) 3) Penis elongates 4) Penis enlarges in breadth and development of glans; rugae appear 5) Adult shape and appearance ```

Enlargement of scrotum and testes; scrotum roughens | and reddens

``` Tanner Staging in boys 1) Preadolescent testes, scrotum, penis 2) Enlargement of scrotum and testes; scrotum roughens and reddens 3) 4) Penis enlarges in breadth and development of glans; rugae appear 5) Adult shape and appearance ```

Penis elongates

``` Tanner Staging in boys 1) Preadolescent testes, scrotum, penis 2) Enlargement of scrotum and testes; scrotum roughens and reddens 3) Penis elongates 4) 5) Adult shape and appearance ```

Penis enlarges in breadth and development of glans; | rugae appear

``` Tanner Staging in boys 1) Preadolescent testes, scrotum, penis 2) Enlargement of scrotum and testes; scrotum roughens and reddens 3) Penis elongates 4) Penis enlarges in breadth and development of glans; rugae appear 5) ```

Adult shape and appearance

A collection of dilated veins around the spermatic cord

Varicocele

Signs/ Symptoms of Varicocele a) Often asymptomatic b) Scrotum pain c) Scrotum looks like a "____ ___ ___" d) Decreased fertility

bag of worms

Management of Varicocele a) ______ for scrotal discomfort b) Surgical ligation, venous embolization

a) NSAIDs

Acute inflammation of infection fo the scrotum, secondary to an inflamed epididymis

Epididymitis

1) Commonly occurring in men < 35 years of age with _____ as the causative agent 2) When occurring in men > 35 years: Likely the result of a bacterial ascension from the bladder or bacteria introduced during cauterization and/ or surgery

chlamydia

Symptoms/ History: Epididymitis a) Pain b) dysuria c) ____/______ d) Low back/ perineal pain e) Fever/ Chills f) Malaise g) Scrotal edema

c) urgency/ frequency

Physical Examination: Epididymitis a) Enlarged, tender epididymis b) A urethral discharge may be evident c) Positive _____ sign d) Normal cremasteric reflex, R/O e) Testicular torsion

c) Prehn's

Diagnostic tests for epididymitis: a) STD testing b) Culture of _____ c) Scrotal ultrasound R/O Testicular torsion

urine

Management of Epididymitis: b) Adults under 35 years: i) ___________ 250 mg IM x1 dose PLUS doxycycline (Vibramycin) 100 mg twice a day or ii) __________ 1 Gram orally once

i) Ceftriaxone (Rocephin) | ii) Azithromycin

Management of Epididymitis: c) Adults over 35 years: i) __________ 1 tablet twice a day x 10 days OR ii) ___________ 250 mg twice a day x 10 days d) Support/ elevate scrotum e) Analgesics, NSAIDs, ice (early), heat (late), bed rest

i) TMP/SMZ- DS | ii) Ciprofloxacin (Cipro)

Inflammatory infection of the prostate

Acute Bacterial Prostatitis

Acute Bacterial Prostatitis | 1. Usually caused by gram-negative bacteria (especially ___ ____

1. E. coli)

Acute Bacterial Prostatitis | 2. Nonbacterial prostatitis (mostly in young men) likely cause: ______, Mycoplasma, Gardnerella

Chlamydia

Symptoms/ history of actual bacterial prostatitis: a) __________ b) lower back pain c) Dysuria d) Urgency frequency e) Nocturia

a) Fever/ chills

Physical examination of acute bacterial prostatitis: | 1) Edematous prostate may be warm tender/ _____ to palpation, pain

boggy

Diagnostic tests for actual bacterial prostatitis: | 1) ____ ____ - positive for the causative agent

1) Urine culture

Management of actual bacterial prostatitis: 1) consult/ refer if septicemia or urinary retention evident 2) Antibiotic choices: ___________ (___), levofloxacin (Levaquin), norfloxacin (Noroxin), ofloxacin (Floxin), other 3) Sitz bath three times a day to 30 minutes eat treatment 4) No sexual intercourse until acute phase resolves

2) Trimethoprim-sulfamethoxazole (Bactrim)

Progressive, benign hyperplasia of prostate

Benign Prostatic Hypertrophy (BPH)

General comments: Benign Prostatic Hypertrophy (BPH) | 1) By the age ____, approximately 50% of men while exhibit signs of BPH

1) 50

General comments: Benign Prostatic Hypertrophy (BPH) 2) By age ____, 80% of men will acquire this disorder 3) Etiology is unknown

2) 80

General comments: Benign Prostatic Hypertrophy (BPH) | 4) The most common cause of bladder ______ in men over the age of 50 years

4) obstruction

Symptoms/ History of BPH: 1) Urgency frequency 2) _______ 3) Dribbling 4) Retention

2) Nocturia

Physical Examination: BPH a) Bladder distention may be present b) The prostate is non-tender with either asymmetrical or symmetrical enlargement c) Smooth _____ consistency with possible nodules

c) rubbery

Laboratory/ diagnostics: a) U/A: Rule out UTI, no hematuria b) Uroflowmetry c) Abdominal ______: Rules out upper tract pathology d) Serum creatinine/ BUN normal e) Prostate-specific antigen (PSA): > 4 ng/ ml indicates disease f) DRE

c) ultrasound

Management of BPH a) Observer condition and consult/ refer to a urologist as needed b) Alpha-blockers: _____ (____), prazosin (Minipress), tamsulosin (Flomax), etc. to relax the muscle of the bladder and prostate

b) Terazosin (Hytrin)

Management of BPH c) 5- alpha-reductase inhibitors: ____ (__) and dutasteride (Avodart) to shrink large prostates d) Saw Palmetto: Effective for some patients

Finasteride (Proscar)

Malignant neoplasm of prostate gland

Prostate cancer

General Comments: Prostate Cancer | a) Prostate cancer is the ____most common cancer among men in the United States

second

General Comments: Prostate Cancer b) The third leading cause of cancer deaths in men older than ____ years of age c) The cause is unknown, through high-fat diets may contribute to the disease

55 years

Symptoms/ History: 1. Patients are usually asymptomatic 2. May appear to be BPH in early stages (e.g. with frequency, nocturia, dribbling) 3. In advanced stages: ____ pain from metastasis uremia secondary to obstruction may occur

Bone

Physical Examination: 1) ______________ 2) Bladder distention 3) Prostate palpates harder than normal with obscure boundaries, and nodules may be present

Adenopathy

Prostate-specific antigen (PSA) values > ___ ng/ml = abnormal; age- specific ranges are based on having had a PSA < ___ ng/ml

Prostate-specific antigen (PSA): Age Value 40 to 49 = < _____

2.5

Prostate-specific antigen (PSA): Age Value 50 to 59 = < ____

3.5

Prostate-specific antigen (PSA): Age Value 60 to 69 = < ____

4.5

Prostate-specific antigen (PSA): Age Value 70 to 79 = < ____

6.5

Thus, the higher the PSA, value, the more likely the diagnosis of cancer ** Approximately ___% of patients with prostate cancer present with normal PSA values

40%

Laboratory/ diagnostics: 2. Needle _____ of the prostate 3. Ultrasound to identify solid nodules

biopsy

Management: Prostate Cancer 1. Consult/ refer 2. Other treatment options: _____, radiation, and hormone therapy

surgery

Inability to sustain an erection capable of intercourse

Erectile Dysfunction

``` A major cause of Erectile dysfunction: 1. Stress a) Psychological issues b) Anxiety (performance) 2. Atherosclerosis 3. Diabetes 4. Recreational drugs a) alcohol b) ___________ c) barbiturates d) cocaine e) Marijuana f) Methadone g) Nicotine h) ```

4. b. Amphetamines

A major cause of Erectile dysfunction: 5. Medications a) Diuretics b) Antihypertensives c) _____________ d) Antidepressants e) Anti- anxiety agents f) Anti-epileptics g) Antihistamines h) NSAIDs i) Muscle relaxants j) Parkinson's disease medications

c) H2 blockers

Management of Erectile dysfunction: 1. Explore underlying causes 2. Check _______ level 3. Phosphodiesterase inhibitors: Caution with concurrent use of nitrates a) Sildenafil (Viagra) b) Vardenafil (Levitra) c) Tadalafil (Cialis) d) Avanafil

2. testosterone

Phosphodiesterase Inhibitors | Sildenafil (Viagra) Works in?

30 minutes

Phosphodiesterase Inhibitors | Sildenafil (Viagra) lasts?

4 hours

Phosphodiesterase Inhibitors | Sildenafil (Viagra) usual dose?

50 mg/d

Phosphodiesterase Inhibitors | Sildenafil (Viagra) max dose?

100 mg/d

Phosphodiesterase Inhibitors | Sildenafil (Viagra) take?

Without food

Phosphodiesterase Inhibitors | Sildenafil (Viagra) available in what dosages?

20, 25, 50, 100 mg

Phosphodiesterase Inhibitors | Vardenafil (Levitra) works?

60 minutes

Phosphodiesterase Inhibitors | Vardenafil (Levitra) lasts?

4 hours

Phosphodiesterase Inhibitors | Vardenafil (Levitra) usual dose?

10 mg/d

Phosphodiesterase Inhibitors | Vardenafil (Levitra) max dose?

20 mg/d

Phosphodiesterase Inhibitors | Vardenafil (Levitra) take?

without food

Phosphodiesterase Inhibitors | Vardenafil (Levitra) available dosage?

2.5, 5, 10, 20 mg

Phosphodiesterase Inhibitors | Tadalafil (Cialis) works?

15 minutes

Phosphodiesterase Inhibitors | Tadalafil (Cialis) Lasts?

up to 36 hours

Phosphodiesterase Inhibitors | Tadalafil (Cialis) usual dose?

10 mg/d

Phosphodiesterase Inhibitors | Tadalafil (Cialis) max dose?

20 mg/d

Phosphodiesterase Inhibitors | Tadalafil (Cialis) take?

with or without food

Phosphodiesterase Inhibitors | Tadalafil (Cialis) available?

5, 10, 20 mg

Phosphodiesterase Inhibitors | Avanafil (Stendra) works?

15 minutes

Phosphodiesterase Inhibitors | Avanafil (Stendra) Lasts?

Up to 36 hours

Phosphodiesterase Inhibitors | Avanafil (Stendra) usual dosage?

100 mg

Phosphodiesterase Inhibitors | Avanafil (Stendra) max dose?

200 mg

Phosphodiesterase Inhibitors | Avanafil (Stendra) take?

with or without food

Phosphodiesterase Inhibitors | Avanafil (Stendra) available?

50, 100, 200 mg

``` Gerontology Considerations Renal: 1. Physiologic changes a. Diminished renal blood flow (up to ___% per decade after the age of 30 to 40) ```

Gerontology Considerations Renal: b. Kidneys decrease in size, both the number and size of nephrons diminish, and the number of glomeruli decreases ______%.

30-40%

Gerontology Considerations Renal: c. GFR diminishes approximately 10% per decade after the age of ___.

Gerontology Considerations Renal: d. Reduced hormonal response to ______ and an impaired ability to conserve sodium (increases the the risk for dehydration)

vasopressin

Gerontology Considerations Renal: e. Bladder tone, elasticity, and capacity are ______

reduced

Gerontology Considerations Renal: f. Increased residual urine and frequency, and more _______ urine production

nocturnal

Gerontology Considerations Renal: g. Prostate ______ in men

enlargement

``` Gerontology Considerations Renal: 2. Possible findings/results a. Decreased drug clearance b. Increased risk of: i) Adverse drug reactions ii) _______ ```

Nephrotoxicity

Gerontology Considerations Renal: iii) Fluid _______ (especially in heart failure patients)

overload

Gerontology Considerations Renal: iv) ________ and dehydration (especially in patients taking thiazide diuretics)

Hyponatremia

Gerontology Considerations Renal: v) ___________ (especially in patients with fever)

Hypernatremia

Gerontology Considerations Renal: vi) __________ (especially in patients taking potassium-sparing diuretics) vii) Metabolic acidosis viii) Urinary urgency ix) Incontinence (never a normal finding) x) UTIs xi) Polyuria at night xii) Falls

Hyperkalemia

*Determine renal function (GFR) by calculating the creatinine clearance in the elderly.

Cockcrofi-Gault Equation:

Cockcrofi-Gault Equation: a. Males: Creatinine clearance (ml/min) =

(140 minus age in years) x (body weight in kg) ------------------------------------------------------------------ 72 x (serum creatinine in mg/dL)

Cockcrofi-Gault Equation: | b. Females: Multiply the calculated value by ____%

85% (0.85)

Normal creatinine clearance values in adults: Males < 40 years = _________ mL/min or 1.8 to 2.3 mL/sec

107 to 139

Normal creatinine clearance values in adults: Females < 40 years = ______ mL/min or 1.5 to 1.8 mL/sec

87 to 107

*Creatinine clearance values usually decrease as one ages (e.g., decrease by ___ mL/min for every 10 years after the age of 20).

6.5

Urinary Tract Infections 1. Epidemiology: The most common clinical illness for adults over 65 years of age a. Men: _____/100 b. Women: 14/100

10.9

Causes: Urinary Tract Infections a. Gram-negative bacilli 1) _____ ______ 2) Pseudomonas aeruginosa

1) Escherichia coli

b. Gram-positive organisms: Urinary Tract Infections 1) _________ 2) Coagulase-negative staphylococci 3) Streptococcus agalactiae 4) S. aureus

Enterococci

c. ____ (especially in those patients with indwelling catheters) Signs/Symptoms a. Classic signs may be absent, may present with: 1) Weakness 2) Frequency 3) Urgency 4) Dysuria

Fungi

b. Atypical findings (More common in elderly in the absence of UTI) 1) Incontinence 2) _____ _____ 3) Lethargy 4) Decreased appetite 5) Dehydration 6) Confusion

Fecal impaction

4) Laboratory/Diagnostics a. Urinalysis i) WBCs may not be present in large numbers. ii) Leucocyte esterase and ____ may be negative.

ii) nitrites

4) Laboratory/Diagnostics b. Culture and Sensitivity i) High incidence of ________ bacteriuria ii) Multiple organisms often present

i) asymptomatic

Genitourinary and Gynecological issues and disorders Flashcards

(264 cards)