GU 4

Question 1

bartholin’s cyst

Answer 1

cyst arising from Bartholin gland, caused by scarring, trauma, edema or idiopathic

Question 2

bartholin’s cyst may become infected and

Answer 2

cause an abscess

Question 3

bartholin’s cyst - pt may present w/
4

Answer 3

1. most asymptomatic
2. +/- vulvar irritation
3. dyspareunia
4. pain w/ sitting/walking

Question 4

bartholin’s cyst - severe pain may indicate what

Answer 4

abscess

Question 5

bartholin’s cyst - PE findings VS
1

Answer 5

1. +/- fever (if abscess present)

Question 6

bartholin’s cyst - cyst PE findings
4

Answer 6

1. unilateral
2. palpable
3. near vaginal introitus and into labia major if large
4. clear discharge

Question 7

bartholin’s cyst - abscess PE findings
5

Answer 7

1. severe unilateral pain
2. swelling
3. redness
4. warm
5. purulent drainage

Question 8

bartholin’s cyst - img/testing
2

Answer 8

1. none usually req
2. if concerned for STI, possible cx

Question 9

bartholin cyst tx for uncomplicated cyst
1st and 2 nd line

Answer 9

1. first line sitz bath
2. second line I/D w/ GYN f/u

Question 10

bartholin cyst tx for abscess

Answer 10

ID w/ word catheter placement (4-6) weeks or gauze packing 48 hours + analgesia coverage

Question 11

bartholin cyst abscess - always incise where

Answer 11

on mucosal surface

Question 12

bartholin cyst abscess - abx information for I/D

Answer 12

1. antimicrobial tx not usually required
2. surrounding cellulitis, recurrent infections, immunosuppression, or STIs are indications for abx therapy

Question 13

bartholin cyst - refer to GYN for
4

Answer 13

abscess
recurrent cysts
age >40 (think vulvar cancer)
size >5cm

Question 14

bartholin cyst - when to refer to ER
3

Answer 14

1. abscess w/ fever
2. extensive cellulitis
3. associated abd pain

Question 15

prostatitis

Answer 15

inflammation of the prostate, +/- infection

Question 16

prostatitis - pt may c/o pain where
6

Answer 16

low back
lower abd
testicular
penile
perineal
myalgias

Question 17

prostatitis - clinical pres
10

Answer 17

1. pain
2. urinary frequency
3. urgency
4. dysuria
5. nocturia
6. poor stream
7. cloudy urine
8. painful ejaculation
9. fever
10. acute vs chronic - more common >50yrs

Question 18

acute prostatitis - PE findings
6

Answer 18

1. tender
2. warm
3. firm
4. edematous prostate (don’t massage)
5. +/- CVA tenderness
6. +/- bladder distention

Question 19

prostatitis - risk factors
9

Answer 19

UTI
cystitis
urethral stricture
BPH
GU instrumentation
prostate cancer
prostate calculi
HIV
unprotected sex

Question 20

chronic prostatitis - PE findings
7

Answer 20

1. prostate may be normal
2. enlarged
3. tender
4. edematous
5. nodular
6. +/- CVA tenderness
7. +/- bladder distention

Question 21

prostatitis - img/testing
2

Answer 21

1. POC urine - if +, urine culture and sensitivity
2. STI testing

Question 22

prostatitis - POC urine, urine may be sterile, negative UA

Answer 22

does not r/o prostatitis

Question 23

prostatitis - DD
6

Answer 23

1. prostate abscess
2. BPH
3. prostate malignancy
4. lower UTI, cystitis, urethritis
5. pyelonephritis
6. epididymitis

Question 24

prostatitis - overall tx disposition
4

Answer 24

1. analgesia
2. antipyretics
3. possible STI testing
4. refer to uro

Question 25

STI associated prostatitis tx

Answer 25

ceftriaxone 500 mg IM once + doxy 100 mg PO BID x 14 days

Question 26

non STI associated prostatitis tx duration

Answer 26

4-6 weeks and refer to PCP

Question 27

non STI associated prostatitis tx 3

Answer 27

1. cipro 500 mg PO BID 2. levofloxacin 500 mg PO once daily 3. Bactrim DS 1 tab PO BID

Question 28

prostatitis - consider what med if concerns for urinary retention

Answer 28

alpha 1 blockers i.e. prazosin/Tamsulosin

Question 29

alpha 1 blockers i.e. prazosin/Tamsulosin - avoid in who

Answer 29

pts on multiple anti hypertensive meds or a fall risk

Question 30

prostatitis - when to refer to ER 1

Answer 30

1. concern for sepsis or urinary obstruction

Question 31

testicular torsion

Answer 31

sudden onset of unilateral testicle pain d/t twisting of the spermatic cord and vascular pedicle resulting in testicular ischemia - uro emergency

Question 32

testicular torsion - patient may present w/ 3

Answer 32

1. acute onset of unilateral mod to severe testicular pain 2. NV 3. diffuse lower abd pain

Question 33

testicular torsion - may follow what 2

Answer 33

vigorous physical activity or trauma

Question 34

testicular torsion - often seen in who

Answer 34

infancy and adolescence but may affect all age groups

Question 35

testicular torsion - PE findings 2

Answer 35

1. asymmetric, high riding testicle in the transverse plane 2. scrotal swelling, erythema, tenderness

Question 36

testicular torsion - PE what two things are not considered reliable findings

Answer 36

cremasteric reflex Prehn's sign

Question 37

testicular torsion - img/testing

Answer 37

clinical dx none

Question 38

testicular torsion - tx 2

Answer 38

1. send to ER 2. in resource limited area, consider manual detorsion using "open book" method - turn testicle away from midline 2-3 full rotations

Question 39

testicular torsion - when to refer to ER

Answer 39

all suspected cases