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FNP Review > GU/GYN > Flashcards

GU/GYN Flashcards

1
Q

Dx criteria for candida

A

Vaginal pH-

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2
Q

Treatment of candida

A

1st choice vaginal insert med

-azole antifungal, oral (Diflucan), vaginal (miconazole, terconazole)

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3
Q

Dx criteria of bacterial vaginosis

A

Vaginal pH- >4.5
Thin, homogeneous, white/gray discharge
Positive Whiff test-fishy odor
>20 clue cells, few or no WBC’s

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4
Q

Treatment of bacterial vaginosis

A

Metronidazole (topical Metrogel), or oral Flagyl.

Clindamycin vaginal cream or ovules (Cleocin)

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5
Q

Dx criteria for atrophic vaginitis

A

Vaginal pH- >5
Scant, white-clear discharge
Few or absent lactobacilli
Sx-itching/burning but often without sx

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6
Q

Treatment of atrophic vaginitis

A

Topical and/or vaginal estrogen if sx are recurrent or if recurrent UTI
Ex- Premarin cream (conjugated estrogen), estrace cream

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7
Q

Acute, uncomplicated UTI treatment

A

Primary- TMP/SMX-DS x 3days, nitrofurantoin (Macrobid) 100mg BID x5days or fosfomycin (Monurol) 3gram X1 dose
*all with pyridium (phenazopyridine)

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8
Q

Alternative tx for UTI (for e-coli resistance to Bactrim or sulfa allergy)

A

Ciprofloxacin 250mg BID, ciprofloxacin ER 500mg QD, Levofloxacin 250mg QD, Moxifloxacin 400mg QD, (all x 3days plus pyridium)

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9
Q

Epididymoorchitis definition

Organisms?

A

Upper reproductive tract infection with inflammation of epididymis/testis
35= enterobacteriaceae

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10
Q

Tx of epididymoorchitis

A

35- Levofloxacin 500mg po QD or Ofloxacin 300mg po BID for 10 days.

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11
Q

Prehn’s test

A

Relief of discomfort with scrotal elevation

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12
Q

Organisms with acute bacterial prostatitis?

A

35- Enterobacteriaceae

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13
Q

Treatment of acute bacterial prostatitis?

A

35- ciprofloxacin 500mg po BID or Ofloxacin 200mg po for 14 days

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14
Q

Urge incontinence sx/tx

A

Reports of strong sensation of needing to void.

Tx- anticholinergics=tolterodine (Detrol), oxybutynin (Ditropan), solifenacin succinate (Vesicare)

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15
Q

Stress incontinence sx/tx

A

Associated with lifting
Tx- support with use of vaginal tampon, urethral stents, and pessary use. Kegel exercises, pelvic floor rehabilitation and bladder training. Surgical intervention in select patients.

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16
Q

Functional incontinence sx/tx

A

Often occurs in presence of mobility problems

Tx- Ameliorated by having assistant who is aware of voiding cues available to help with toileting.

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17
Q

Transient incontinence sx/tx

A

Occurs during an acute illness

Tx- treat underlying process, discontinuation of offending medications.

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18
Q

Phimosis

A

The foreskin cannot be pulled back to expose the glans

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19
Q

Paraphimosis

A

Retracted foreskin that cannot be brought forward to cover the glans

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20
Q

Variocele

A

A palpable “bag of worms” scrotal mass that is only evident in standing position.

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21
Q

Hydrocele

A

Collection of serous fluid that causes painless scrotal swelling easily recognized by transillumination

22
Q

Testicular torsion

A

Scrotal pain and loss of the cremasteric reflex

23
Q

Cryptochidism

A

Testicle located in inguinal canal or abdomen

24
Q

Anticholinergics/Antispasmodics action and examples

A

Action- relaxes bladder smooth muscle, inhibits involuntary detrusor muscle contractions
Ex- tolterodine (Detrol LA)
Oxybutynin (Ditropan XL)
Solifenacin (Vesicare)

25
Q

Alpha-1 adrenergic blocking agents action and examples

A

Selectively antagonizes prostate alpha adrenergic receptors relaxing smooth muscle and improving urine flow.
Ex- tamsulosin hydrochloride (Flomax)
Terazosin hydrochloride (Hytrin)
Doxazosin mesylate (Cardura)

26
Q

Causes of hematuria

A

Isolated- bleed anywhere from renal pelvis to the urethra.
RBC casts- injury to nephron.
Gross hematuria- acute cystitis, urethritis.
Proteinuria and hematuria- glomerular or interstitial nephritis.
Colicky flank pain- urethral stones

27
Q

Meds/foods that may cause hematuria or act as bladder irritants

A

Meds- beta-lactam antibiotics, sulfonamides, NSAIDS, rifampin, cipro, zyloprim, Tagamet, Dilantin, anticoagulants.
Foods- caffeine, spices, chocolate, ETOH, citrus, soy sauce

28
Q

Causes of proteinuria

A

If more than 2g in 24 hrs, glomerular cause is most likely.
Benign functional- orthostatic proteinuria, environmental conditions, fever, acute illness.
*When found in a low-risk patient, urine should be tested for Bence-Jones protein (associated with multiple myeloma)

29
Q

Proteinuria 3-3.5 g/day is inductive of what condition?

A

Nephrotic syndrome

30
Q

Nephrotic syndrome definition

A

Syndrome in which protein is lost through the kidney (proteinuria), this causes low protein in the blood (hypoalbuminemia), this causes water to shift to soft tissue (edema).
*refer to nephrology

31
Q

Pyelonephritis definition

A

Upper UTI, infection of the kidney, characterized by infection within the renal pelvis, tubules or interstitial tissue.
Acute- infection ascending from the bladder
Chronic- usually no specific pathological explanation

32
Q

UA findings with pyelonephritis

A

Positive bacteria, proteinuria, leukocyte esterase, urinary nitrates, hematuria, pyuria, and WBC casts.

33
Q

What finding can help differentiate pyelonephritis from cystitis?

A

WBC casts. This is seen with pyelonephritis and it indicates inflammation of the kidney- such casts will not form except in the kidney.

34
Q

What “zone” does BPH develop? CA develop?

A

BPH- transitional zone

Prostate CA- peripheral zone

35
Q

BPH diagnostics

A

UA to rule out infection (prostatitis)
PSA- usually less than 10ng/ml
Urine cytology should be performed to rule out carcinoma particularly when hematuria is present

36
Q

BPH sx

A 
Nocturia
Urine frequency
Urgency/dysuria
Urge incontinence/retention 
Decreased force of stream 
Hesitancy 
Post-void dribbling
37
Q

BPH treatment

A

Alpha1-adrenergic agonists (Minipress, Hytrin, Cardura)

Subtype alpha1a- adrenergic receptor targets (Flomax, Uroxatral)

5-alpha reductase inhibitors (Proscar, Avodart)

38
Q

Erectile dysfunction dx tests

A 
BG to rule out DM 
Lipid profile 
TSH
Testosterone level 
CBC PSA
39
Q

Organic causes of ED

A

Obesity (BMI >31), metabolic syndrome, smoking, lack of exercise, DM, hyper cholesterol, HTN, age >40
meds- HCTZ, antidepressants

40
Q

ED treatments

A 
Sildenafil (Viagra) 25-100mg on demand dosing 
Tadalafil (Cialis) 5mg QD or 10-20mg on demand 
Vardenafil hydrochloride (Levitra) 10-20 mg on demand
41
Q

Vaginal bleeding in a post menopausal woman is a red flag for what disease?

A

Endometrial cancer

42
Q

Polycystic ovary syndrome definition

A

Defined by the presence of anovulation, polycystic ovaries on US, and clinical or biochemical hyper-androgenism
*genetic factors and insulin resistance play a role in the pathogenesis of PCOS

43
Q

Pathophysiology of PCOS

A

The result of a defect in the hypothalamic pituitary-ovarian circuit.

44
Q

PCOS diagnostic criteria

A

Any 2/3 confirmed:

  • Oligomenorrhea or amenorrhea
  • Hyperandrogenism (hirsutism, acne, alopecia or
  • Hyperandrogenemia (high levels of testosterone)
  • Polysystic ovaries on US
45
Q

Long term health risks of PCOS

A

T2DM, CAD, Metabolic syndrome/insulin resistance, 2.7 fold increased risk of endometrial CA, mood disorders (anxiety/depression)

46
Q

Management of PCOS

A

Weight reduction, lipid lowering meds (statins, nicotinic acid), insulin sensitizers (metformin, TZD’s), oral contraception and anti-androgens

47
Q

Genital herpes clinical findings/tx

A

Painful, ulcerated lesions, marked lymphadenopathy with initial lesion. Grouped vesicles on erythematous base.
Tx-acyclovir (Zovirax), vancyclovir, famciclovir

48
Q

Chlamydia trachomatis clinical findings/tx

A

Occasional mucopurulent discharge

Tx- Azithromycin 1g PO one time dose

49
Q

Gonococcal inf clinical findings/tx

A

Occasional purulent discharge

Tx- Ceftriaxone 250mg IM one time dose, plus Azithromycin 1g (co-treat for chlamydia)

50
Q

Trichomoniasis clinical findings/tx

A

Yellow-green vaginal discharge, occasionally frothy, cervical petechial hemorrhages
Tx- oral metronidazole 2g as one time dose
Alt option metronidazole 500mg po BID x7 days

51
Q

Syphillis clinical findings and treatment

A

Primary- painless genital lesion/anal ulcer.
Secondary- non-pruritic rash on palms and soles, mucus membranes
Latent- neurosyphillis, dementia, ataxia
Tx- Injectable PCN, doxycycline in pts with beta lactam allergy

52
Q

Genital warts (condyloma) clinical findings/tx

A

Verruca form lesions can be subclinical or unrecognized
Tx- prevention with immunization.
imiquimod (Aldara), surgical removal, cryotherapy

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